Methods for the diagnosis of ovarian cancer health states and risk of ovarian cancer health states

ABSTRACT

The present invention describes a method for predicting a health-state indicative of the presence of ovarian cancer (OC). The method measures the intensities of specific small organic molecules, called metabolites, in a blood sample from a patient with an undetermined health-state, and compares these intensities to those observed in a population of healthy individuals and/or to the intensities previously observed in a population of confirmed ovarian cancer-positive individuals. Specifically, the present invention relates to the diagnosis of OC through the measurement of vitamin E isoforms and related metabolites. The method enables a practitioner to determine the probability that a screened patient is positive or at risk for ovarian cancer.

This application is a divisional of U.S. patent application Ser. No. 12/524,641, which is a national stage application under 35 U.S.C. 371 of PCT/CA2008/000270, filed Feb. 1, 2008, and claims the benefit of U.S. Provisional Patent Application Ser. No. 60/887,693, filed Feb. 1, 2007.

FIELD OF INVENTION

The present invention relates to small molecules or metabolites that are found to have significantly different abundances or intensities between clinically diagnosed ovarian cancer-positive patients and normal disease-free subjects. The present invention also relates to methods for diagnosing ovarian cancer, or the risk of developing ovarian cancer.

BACKGROUND OF THE INVENTION

Ovarian cancer is the fifth leading cause of cancer death among women (1). It has been estimated that over 22,000 new cases of ovarian cancer will be diagnosed this year, with 16,210 deaths predicted in the United States alone (2). Ovarian cancer is typically not identified until the patient has reached stage III or IV, which is associated with a poor prognosis; the five-year survival rate is estimated at around 25-30% (3). The current screening procedures for ovarian cancer involve the combination of bimanual pelvic examination, transvaginal ultrasonography, and serum screening for elevated cancer antigen-125 (CA125), a protein cancer antigen (2). The efficacy of CA125 screening for ovarian cancer is currently of unknown benefit, as there is a lack of evidence that the screen reduces mortality rates, and it is under scrutiny due to the risks associated with false positive results (1, 4). According to the American Cancer Society, CA125 measurement and transvaginal ultrasonography are not reliable screening or diagnostic tests for ovarian cancer, and that the only current method available to make a definite diagnosis is by surgery.

CA125 is a high molecular weight mucin that has been found to be elevated in most ovarian cancer cells as compared to normal cells (2). A CA125 test result that is higher than 30-35 U/ml is typically accepted as being at an elevated level (2). There have been difficulties in establishing the accuracy, sensitivity, and specificity of the CA125 screen for ovarian cancer due to the different thresholds used to define elevated CA125, varying sizes of patient groups tested, and broad ranges in the age and ethnicity of patients (1). According to the Johns Hopkins University pathology website, the CA125 test only returns a true positive result for ovarian cancer in roughly 50% of stage I patients and about 80% in stage II, III and IV patients. Endometriosis, benign ovarian cysts, pelvic inflammatory disease, and even the first trimester of a pregnancy have all been reported to increase the serum levels of CA125 (4). The National Institute of Health's website states that CA125 is not an effective general screening test for ovarian cancer. They report that only about three out of 100 healthy women with elevated CA125 levels are actually found to have ovarian cancer, and about 20% of ovarian cancer diagnosed patients actually have elevated CA125 levels.

It is clear that there is a need for improving ovarian cancer detection. A test that is able to detect risk for, or the presence of, ovarian cancer or that can predict aggressive disease with high specificity and sensitivity would be very beneficial and would impact ovarian cancer morbidity.

SUMMARY OF THE INVENTION

The present invention relates to small molecules or metabolites that are found to have significantly different abundances between persons with ovarian cancer, and normal subjects.

The present invention provides a method for identifying, validating, and implementing a high-throughput screening (HTS) assay for the diagnosis of a health-state indicative of ovarian cancer or at risk of developing ovarian cancer. In a particular example, the method encompasses the analysis of ovarian cancer-positive and normal biological samples using non-targeted Fourier transform ion cyclotron mass spectrometry (FTMS) technology to identify all statistically significant metabolite features that differ between normal and ovarian cancer-positive biological samples, followed by the selection of the optimal feature subset using multivariate statistics, and characterization of the feature set using methods including, but not limited to, chromatographic separation, mass spectrometry (MS/MS), and nuclear magnetic resonance (NMR), for the purposes of:

-   -   1. Separating and identifying retention times of the         metabolites;     -   2. Producing descriptive MS/MS fragmentation patterns specific         for each metabolite;     -   3. Elucidating the molecular structure; and     -   4. Developing a high-throughput quantitative or         semi-quantitative MS/MS-based diagnostic assay, based upon, but         not limited to, tandem mass spectrometry.

The present invention further provides a method for the diagnosis of ovarian cancer or the risk of developing ovarian cancer in humans by measuring the levels of specific small molecules present in a sample and comparing them to “normal” reference levels. The methods measure the intensities of specific small molecules, also referred to as metabolites, in the sample from the patient, and compare these intensities to the intensities observed in a population of healthy individuals. The sample obtained from the human may be a blood sample.

The present invention may significantly improve the ability to detect ovarian cancer or the risk of developing ovarian cancer, and may therefore save lives. The statistical performance of a test based on these samples suggests that the test will outperform the CA125 test, the only other serum-based diagnostic test for ovarian cancer. Alternatively, a combination of the test described herein and the CA125 test may improve the overall diagnostic performance of each test. The methods of the present invention, including development of HTS assays, can be used for the following, wherein the specific “health-state” refers to, but is not limited to, ovarian cancer:

1. Identifying small-molecule metabolite biomarkers which can discriminate between ovarian cancer-positive and ovarian cancer-negative individuals using any biological sample taken from the individual;

2. Specifically diagnosing ovarian cancer using metabolites identified in a sample such as serum, plasma, whole blood, and/or other tissue biopsy as described herein;

3. Selecting a number of metabolite features from a larger subset required for optimal diagnostic assay performance statistics using various statistical methods such as those mentioned herein;

4. Identifying structural characteristics of biomarker metabolites selected from non-targeted metabolomic analysis using LC-MS/MS, MS^(n), and NMR;

5. Developing a high-throughput tandem MS method for assaying selected metabolite levels in a sample;

6. Diagnosing ovarian cancer, or the risk of developing ovarian cancer, by determining the levels of any combination of metabolite features disclosed from the FTMS analysis of patient sample, using any method including, but not limited to, mass spectrometry, NMR, UV detection, ELISA (enzyme-linked immunosorbant assay), chemical reaction, image analysis, or other;

7. Monitoring any therapeutic treatment of ovarian cancer, including drug (chemotherapy), radiation therapy, surgery, dietary, lifestyle effects, or other;

8. Longitudinal monitoring or screening of the general population for ovarian cancer using any single or combination of features disclosed in the method;

9. Determining or predicting the effect of treatment, including surgery, chemotherapy, radiotherapy, biological therapy, or other.

10. Determining or predicting tumor subtype, including disease stage and aggressiveness.

In one embodiment of the present invention there is provided a panel of metabolites that differ between the normal and the ovarian cancer-positive samples (p<0.05). Four hundred and twenty four metabolites met this criterion, as shown in Table 1. These metabolites differ statistically between the two populations and therefore have potential diagnostic utility. Therefore, one embodiment of the present invention is directed to the 424 metabolites, or a subpopulation thereof. A further embodiment of the present invention is directed to the use of the 424 metabolites, or a subpopulation thereof for diagnosing ovarian cancer, or the risk of developing ovarian cancer.

In a further embodiment of the present invention there is provided a number of metabolites that have statistically significant different abundances or intensities between ovarian cancer-positive and normal samples. Of the metabolite masses identified, any subpopulation thereof could be used to differentiate between ovarian cancer-positive and normal states. An example is provided in the present invention whereby a panel of 37 metabolite masses is further selected and shown to discriminate between ovarian cancer and control samples.

In this embodiment of the present invention, there is provided a panel of 37 metabolite masses that can be used as a diagnostic indicator of disease presence in serum samples. The 37 metabolites can include those with masses (measured in Daltons) 440.3532, 446.3413, 448.3565, 450.3735, 464.3531, 466.3659, 468.3848, 474.3736, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 502.4055, 504.4195, 510.3943, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 534.3913, 538.427, 540.4393, 548.4442, 550.4609, 558.4653, 566.4554, 574.4597, 576.4762, 578.493, 590.4597, 592.4728, 594.4857, 596.5015, 598.5121, where a +/−5 ppm difference would indicate the same metabolite. This embodiment of the present invention also includes the use of the 37 metabolites, or a subpopulation thereof for diagnosing ovarian cancer or the risk of developing ovarian cancer.

In a further embodiment of the present invention, there is provided a panel of 31 metabolite masses that can be used as a diagnostic indicator of disease presence in serum samples. The 31 metabolites can include those with masses (measured in Daltons) 446.3413, 448.3565, 450.3735, 468.3848, 474.3872, 476.5, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 496.4157, 502.4055, 504.4195, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 538.427, 540.4393, 550.4609, 558.4653, 574.4597, 576.4757, 578.4848, 592.357, 594.4848, 596.5012, 598.5121, where a +/−5 ppm difference would indicate the same metabolite. This embodiment of the present invention also includes the use of the 31 metabolites, or a subpopulation thereof for diagnosing ovarian cancer or the risk of developing ovarian cancer.

In a further embodiment of the present invention, there is provided a panel of 30 metabolite masses that can be used as a diagnostic indicator of disease presence in serum samples. The 30 metabolites can include those with masses (measured in Daltons) substantially equivalent to 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, and 598.5172, where a +/−5 ppm difference would indicate the same metabolite. This embodiment of the present invention also includes the use of the 30 metabolites, or a subpopulation thereof for diagnosing ovarian cancer or the risk of developing ovarian cancer. In this embodiment of the invention the molecular formulas of the metabolites with these masses are C28H46O4, C28H48O4, C28H50O4, C28H52O5, C30H50O4, C30H54O4, C28H52O6, C30H50O5, C30H52O5, C30H54O5, C30H56O5, C32H54O4, C32H56O4, C30H56O6, C32H54O5, C32H56O5, C32H60O5, C34H58O4, C34H60O4, C32H58O6, C32H60O6, C34H62O5, C36H62O4, C36H62O5, C36H64O5, C36H66O5, C36H64O6, C36H66O6, C36H68O6, and C36H70O6, respectively and the proposed structures are as shown below:

respectively.

In a further embodiment of the present invention, there is provided a panel of six C28 carbon molecules (neutral masses 450 (C28H50O4), 446 (C28H46O4), 468 (C28H52O5), 448 (C28H48O4), 464 (C28H48O5) and 466 (C28H50O5)) that were found to be significantly lower in serum of the ovarian patients as compared to controls.

In one embodiment of the present invention there is provided a method for identifying metabolites to diagnose ovarian cancer comprising the steps of: introducing a sample from a patient presenting said disease state, with said sample containing a plurality of unidentified metabolites, into a high resolution mass spectrometer, for example, a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTMS); obtaining, identifying, and quantifying data for the metabolites; creating a database of said data; comparing said data from the sample with corresponding data from samples of a control population; identifying one or more metabolites that differ; and selecting the minimal number of metabolite markers needed for optimal diagnosis.

In a further embodiment of the present invention there is provided a method for identifying ovarian cancer-specific metabolic markers comprising the steps of: introducing a sample from a patient diagnosed for ovarian cancer, with said sample containing a plurality of unidentified metabolites, into a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTMS); obtaining, identifying, and quantifying data for the metabolites; creating a database of said data; comparing said data from the sample with corresponding data from a control sample; identifying one or more metabolites that differ, wherein the metabolites are selected from the group consisting of metabolites with accurate masses (measured in Daltons) of, or substantially equivalent to, 440.3532, 446.3413, 448.3565, 450.3735, 464.3531, 466.3659, 468.3848, 474.3736, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 502.4055, 504.4195, 510.3943, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 534.3913, 538.427, 540.4393, 548.4442, 550.4609, 558.4653, 566.4554, 574.4597, 576.4762, 578.493, 590.4597, 592.4728, 594.4857, 596.5015, 598.5121, where a +/−5 ppm difference would indicate the same metabolite.

In a further embodiment of the present invention there is provided a method for identifying ovarian cancer-specific metabolic markers comprising the steps of: introducing a sample from a patient diagnosed for ovarian cancer, with said sample containing a plurality of unidentified metabolites, into a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTMS); obtaining, identifying, and quantifying data for the metabolites; creating a database of said data; comparing said data from the sample with corresponding data from a control sample; identifying one or more metabolites that differ, wherein the metabolites are selected from the group consisting of metabolites with accurate masses (measured in Daltons) of, or substantially equivalent to, 446.3413, 448.3565, 450.3735, 468.3848, 474.3872, 476.5, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 496.4157, 502.4055, 504.4195, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 538.427, 540.4393, 550.4609, 558.4653, 574.4597, 576.4757, 578.4848, 592.357, 594.4848, 596.5012, 598.5121, where a +/−5 ppm difference would indicate the same metabolite.

In a further embodiment of the present invention there is provided a method for identifying ovarian cancer-specific metabolic markers comprising the steps of: introducing a sample from a patient diagnosed for ovarian cancer, with said sample containing a plurality of unidentified metabolites, into a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTMS); obtaining, identifying, and quantifying data for the metabolites; creating a database of said data; comparing said data from the sample with corresponding data from a control sample; identifying one or more metabolites that differ, wherein the metabolites are selected from the group consisting of metabolites with accurate masses (measured in Daltons) of, or substantially equivalent to 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, and 598.5172, where a +/−5 ppm difference would indicate the same metabolite In this embodiment of the invention the molecular formulas of the metabolites with these masses are C28H46O4, C28H48O4, C28H50O4, C28H52O5, C30H50O4, C30H54O4, C28H52O6, C30H50O5, C30H52O5, C30H54O5, C30H56O5, C32H54O4, C32H56O4, C30H56O6, C32H54O5, C32H56O5, C32H60O5, C34H58O4, C34H60O4, C32H58O6, C32H60O6, C34H62O5, C36H62O4, C36H62O5, C36H64O5, C36H66O5, C36H64O6, C36H66O6, C36H68O6, and C36H70O6, respectively and the proposed structures are as shown below:

respectively.

In a further embodiment of the present invention there is provided a method for identifying ovarian cancer-specific metabolic markers comprising the steps of: introducing a sample from a patient diagnosed for ovarian cancer, with said sample containing a plurality of unidentified metabolites, into a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTMS); obtaining, identifying, and quantifying data for the metabolites; creating a database of said data; comparing said data from the sample with corresponding data from a control sample; identifying one or more metabolites that differ, wherein the metabolites are selected from the group consisting of metabolites with accurate masses of, or substantially equivalent to six C28 carbon molecules (neutral masses 450 (C28H50O4), 446 (C28H46O4), 468 (C28H52O5), 448 (C28H48O4), 464 (C28H48O5) and 466 (C28H50O5)).

In yet a further embodiment of the present invention there is provided an ovarian cancer-specific metabolic marker selected from the group consisting of metabolites with an accurate mass (measured in Daltons) of, or substantially equivalent to, 440.3532, 446.3413, 448.3565, 450.3735, 464.3531, 466.3659, 468.3848, 474.3736, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 502.4055, 504.4195, 510.3943, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 534.3913, 538.427, 540.4393, 548.4442, 550.4609, 558.4653, 566.4554, 574.4597, 576.4762, 578.493, 590.4597, 592.4728, 594.4857, 596.5015, 598.5121, where a +/−5 ppm difference would indicate the same metabolite.

In yet a further embodiment of the present invention there is provided an ovarian cancer-specific metabolic marker selected from the group consisting of metabolites with an accurate mass (measured in Daltons) of, or substantially equivalent to, 446.3413, 448.3565, 450.3735, 468.3848, 474.3872, 476.5, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 496.4157, 502.4055, 504.4195, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 538.427, 540.4393, 550.4609, 558.4653, 574.4597, 576.4757, 578.4848, 592.357, 594.4848, 596.5012, 598.5121, where a +/−5 ppm difference would indicate the same metabolite.

In yet a further embodiment of the present invention there is provided an ovarian cancer-specific metabolic marker selected from the group consisting of metabolites with an accurate mass (measured in Daltons) of, or substantially equivalent to 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, and 598.5172, where a +/−5 ppm difference would indicate the same metabolite. In this embodiment of the invention the molecular formulas of the metabolites with these masses are C28H46O4, C28H48O4, C28H50O4, C28H52O5, C30H50O4, C30H54O4, C28H52O6, C30H50O5, C30H52O5, C30H54O5, C30H56O5, C32H54O4, C32H56O4, C30H56O6, C32H54O5, C32H56O5, C32H60O5, C34H58O4, C34H60O4, C32H58O6, C32H60O6, C34H62O5, C36H62O4, C36H62O5, C36H64O5, C36H66O5, C36H64O6, C36H66O6, C36H68O6, and C36H70O6, respectively and the proposed structures are as shown below:

respectively.

In a further embodiment of the present invention there is provided a method for diagnosing a patient for the presence of an ovarian cancer, or the risk of developing ovarian cancer, comprising the steps of: screening a sample from said patient for the presence or absence of one or more metabolic markers selected from the group consisting of metabolites with an accurate mass of, or substantially equivalent to, the masses in Table 1, where a +/−5 ppm difference would indicate the same metabolite; wherein the absence or significant reduction of one or more of said metabolic markers indicates the presence of an ovarian cancer, or the risk of developing ovarian cancer, and wherein the method is a FTMS based method.

In a further embodiment of the present invention there is provided a method for diagnosing a patient for the presence of an ovarian cancer, or the risk of developing ovarian cancer, comprising the steps of: screening a sample from said patient for the presence or absence of one or more metabolic markers selected from the group consisting of metabolites with an accurate mass (measured in Daltons) of, or substantially equivalent to, 440.3532, 446.3413, 448.3565, 450.3735, 464.3531, 466.3659, 468.3848, 474.3736, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 502.4055, 504.4195, 510.3943, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 534.3913, 538.427, 540.4393, 548.4442, 550.4609, 558.4653, 566.4554, 574.4597, 576.4762, 578.493, 590.4597, 592.4728, 594.4857, 596.5015, 598.5121, where a +/−5 ppm difference would indicate the same metabolite; wherein the absence or significant reduction of one or more of said metabolic markers indicates the presence of an ovarian cancer, or the risk of developing ovarian cancer.

In a further embodiment of the present invention there is provided a method for diagnosing a patient for the presence of an ovarian cancer, or the risk of developing ovarian cancer, comprising the steps of: screening a sample from said patient for the presence or absence of one or more metabolic markers selected from the group consisting of metabolites with an accurate mass (measured in Daltons) of, or substantially equivalent to, 446.3413, 448.3565, 450.3735, 468.3848, 474.3872, 476.5, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 496.4157, 502.4055, 504.4195, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 538.427, 540.4393, 550.4609, 558.4653, 574.4597, 576.4757, 578.4848, 592.357, 594.4848, 596.5012, 598.5121, where a +/−5 ppm difference would indicate the same metabolite; wherein the absence or significant reduction of one or more of said metabolic markers indicates the presence of an ovarian cancer, or the risk of developing ovarian cancer.

In a further embodiment of the present invention there is provided a method for diagnosing a patient for the presence of an ovarian cancer, or the risk of developing ovarian cancer, comprising the steps of: screening a sample from said patient for the presence or absence of one or more metabolic markers selected from the group consisting of metabolites with an accurate mass (measured in Daltons) of, or substantially equivalent to masses to 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, and 598.5172, where a +/−5 ppm difference would indicate the same metabolite; wherein the absence or significant reduction of one or more of said metabolic markers indicates the presence of an ovarian cancer, or the risk of developing ovarian cancer. In this embodiment of the invention the molecular formulas of the metabolites with these masses are C28H46O4, C28H48O4, C28H50O4, C28H52O5, C30H50O4, C30H54O4, C28H52O6, C30H50O5, C30H52O5, C30H54O5, C30H56O5, C32H54O4, C32H56O4, C30H56O6, C32H54O5, C32H56O5, C32H60O5, C34H58O4, C34H60O4, C32H58O6, C32H60O6, C34H62O5, C36H62O4, C36H62O5, C36H64O5, C36H66O5, C36H64O6, C36H66O6, C36H68O6, and C36H70O6, respectively and the proposed structures are as shown below:

respectively.

In a further embodiment of the present invention there is provided a method for diagnosing a patient for the presence of an ovarian cancer, or the risk of developing ovarian cancer, comprising the steps of: screening a sample from said patient for the presence or absence of one or more metabolic markers selected from the group consisting of metabolites with an accurate mass of, or substantially equivalent to neutral masses 450 (C28H50O4), 446 (C28H46O4), 468 (C28H52O5), 448 (C28H48O4), 464 (C28H48O5) and 466 (C28H50O5) wherein the absence or significant reduction of one or more of said metabolic markers indicates the presence of an ovarian cancer, or the risk of developing ovarian cancer.

In a further embodiment of the present invention there is provided a method for diagnosing the presence or absence of ovarian cancer in a test subject of unknown ovarian cancer status, comprising: analyzing a blood sample from a test subject to obtain quantifying data on molecules selected from the group comprised of molecules identified by the neutral accurate masses shown in Table 1, where a +/−5 ppm difference would indicate the same metabolite, or molecules having masses substantially equal to these molecules or fragments of derivatives thereof; comparing the quantifying data obtained on said molecules in said test subject with quantifying data obtained from said molecules from a plurality of ovarian cancer-positive humans or quantifying data obtained from a plurality of ovarian cancer-negative humans; and wherein said comparison can be used to determine the probability that the test subject is ovarian cancer-positive or -negative.

In a further embodiment of the present invention there is provided a method for diagnosing the presence or absence of ovarian cancer in a test subject of unknown ovarian cancer status, comprising: analyzing a blood sample from a test subject to obtain quantifying data on molecules selected from the group comprised of molecules identified by the neutral accurate masses (measured in Daltons) 440.3532, 446.3413, 448.3565, 450.3735, 464.3531, 466.3659, 468.3848, 474.3736, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 502.4055, 504.4195, 510.3943, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 534.3913, 538.427, 540.4393, 548.4442, 550.4609, 558.4653, 566.4554, 574.4597, 576.4762, 578.493, 590.4597, 592.4728, 594.4857, 596.5015, 598.5121, where a +/−5 ppm difference would indicate the same metabolite, or molecules having masses substantially equal to these molecules or fragments of derivatives thereof; comparing the quantifying data obtained on said molecules in said test subject with quantifying data obtained from said molecules from a plurality of ovarian cancer-positive humans or quantifying data obtained from a plurality of ovarian cancer-negative humans; and wherein said comparison can be used to determine the probability that the test subject is ovarian cancer-positive or -negative.

In a further embodiment of the present invention there is provided a method for diagnosing the presence or absence of ovarian cancer in a test subject of unknown ovarian cancer status, comprising: analyzing a blood sample from a test subject to obtain quantifying data on molecules selected from the group comprised of molecules identified by the neutral accurate masses (measured in Daltons) 446.3413, 476.5, 448.3565, 450.3735, 468.3848, 474.3872, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 496.4157, 502.4055, 504.4195, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 538.427, 540.4393, 550.4609, 558.4653, 574.4597, 576.4757, 578.4848, 592.357, 594.4848, 596.5012, 598.5121, where a +/−5 ppm difference would indicate the same metabolite, or molecules having masses substantially equal to these molecules or fragments of derivatives thereof; comparing the quantifying data obtained on said molecules in said test subject with quantifying data obtained from said molecules from a plurality of ovarian cancer-positive humans or quantifying data obtained from a plurality of ovarian cancer-negative humans; and wherein said comparison can be used to determine the probability that the test subject is ovarian cancer-positive or -negative.

In a further embodiment of the present invention there is provided a method for diagnosing the presence or absence of ovarian cancer in a test subject of unknown ovarian cancer status, comprising: analyzing a blood sample from a test subject to obtain quantifying data on molecules selected from the group comprised of molecules identified by the neutral accurate masses (measured in Daltons) 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, and 598.5172, where a +/−5 ppm difference would indicate the same metabolite, or molecules having masses substantially equal to these molecules or fragments of derivatives thereof; comparing the quantifying data obtained on said molecules in said test subject with quantifying data obtained from said molecules from a plurality of ovarian cancer-positive humans or quantifying data obtained from a plurality of ovarian cancer-negative humans; and wherein said comparison can be used to determine the probability that the test subject is ovarian cancer-positive or -negative. In this embodiment of the invention the molecular formulas of the metabolites with these masses are C28H46O4, C28H48O4, C28H50O4, C28H52O5, C30H50O4, C30H54O4, C28H52O6, C30H50O5, C30H52O5, C30H54O5, C30H56O5, C32H54O4, C32H56O4, C30H56O6, C32H54O5, C32H56O5, C32H60O5, C34H58O4, C34H60O4, C32H58O6, C32H60O6, C34H62O5, C36H62O4, C36H62O5, C36H64O5, C36H66O5, C36H64O6, C36H66O6, C36H68O6, and C36H70O6, respectively and the proposed structures are as shown below:

respectively.

In a further embodiment of the present invention there is provided a method for diagnosing the presence or absence of ovarian cancer in a test subject of unknown ovarian cancer status, comprising: analyzing a blood sample from a test subject to obtain quantifying data on molecules selected from the group comprised of molecules identified by the neutral accurate masses 450 (C28H50O4), 446 (C28H46O4), 468 (C28H52O5), 448 (C28H48O4), 464 (C28H48O5) and 466 (C28H50O5) comparing the quantifying data obtained on said molecules in said test subject with quantifying data obtained from said molecules from a plurality of ovarian cancer-positive humans or quantifying data obtained from a plurality of ovarian cancer-negative humans; and wherein said comparison can be used to determine the probability that the test subject is ovarian cancer-positive or -negative.

The identification of ovarian cancer biomarkers with improved diagnostic accuracy in human serum, therefore, would be extremely beneficial, as the test would be non-invasive and could possibly be used to monitor individual susceptibility to disease prior to, or in combination with, conventional methods. A serum test is minimally invasive and would be accepted across the general population. The present invention relates to a method of diagnosing ovarian cancer, or the risk of developing ovarian cancer, by measuring the levels of specific small molecules present in human serum and comparing them to “normal” reference levels. The invention discloses several hundred metabolite masses which were found to have statistically significant differential abundances between ovarian cancer-positive serum and normal serum, of which in one embodiment of the present invention a subset of 37, and in a further embodiment a subset of 31 metabolite masses, a further subset of 30 metabolite masses and a further subset of 6 metabolite markers are used to illustrate the diagnostic utility by discriminating between disease-positive serum and control serum samples. In yet a further embodiment of the present invention, any one or combination of the metabolites identified in the present invention can be used to indicate the presence of ovarian cancer. A diagnostic assay based on small molecules, or metabolites, in serum fulfills the above criteria for an ideal screening test, as development of assays capable of detecting specific metabolites is relatively simple and cost effective per assay. Translation of the method into a clinical assay compatible with current clinical chemistry laboratory hardware would be commercially acceptable and effective, and would result in a rapid deployment worldwide. Furthermore, the requirement for highly trained personnel to perform and interpret the test would be eliminated.

The selected 31 metabolites, identified according to the present invention, were further characterized by molecular formulae and structure. This additional information for 30 of the metabolites is shown in Table 35.

The present invention also discloses the identification of vitamin E-like metabolites that are differentially expressed in the serum of OC-positive patients versus healthy controls. The differential expressions disclosed are specific to OC.

In one embodiment of the present invention, a serum test, developed using an optimal subset of metabolites selected from the group consisting of vitamin E-like metabolites, can be used to diagnose the presence of OC, or the risk of developing ovarian cancer, or the presence of an OC-promoting or inhibiting environment.

In another embodiment of the present invention, a serum test, developed using an optimal subset of metabolites selected from the group consisting of vitamin E-like metabolites, can be used to diagnose the OC health-state resulting from the effect of treatment of a patient diagnosed with OC. Treatment may include chemotherapy, surgery, radiation therapy, biological therapy, or other.

In another embodiment of the present invention, a serum test, developed using an optimal subset of metabolites selected from the group consisting of vitamin E-like metabolites, can be used to longitudinally monitor the OC status of a patient on a OC therapy to determine the appropriate dose or a specific therapy for the patient.

The present invention also discloses the identification of gamma-tocopherol/tocotrienol metabolites in which the aromatic ring structure has been reduced that are differentially expressed in the serum of OC-positive patients versus healthy controls. The differential expressions disclosed are specific to OC. Therefore, according to the present invention, the metabolites can be used to monitor irregularities or abnormalities in the biological pathways or systems associated with ovarian cancer.

The present invention discloses the presence of gamma-tocopherol/tocotrienol metabolites in which there exists —OC2H5, —OC4H9, or —OC8H17 moieties attached to the hydroxychroman-containing structure in human serum.

In a further embodiment of the present invention there is provided a method for identifying and diagnosing individuals who would benefit from anti-oxidant therapy comprising: analyzing a blood sample from a test subject to obtain quantifying data on all, or a subset of, gamma tocopherols, gamma tocotrienols, omega-carboxylated gamma tocopherol and gamma tocotrienol, vitamin E-related metabolites or metabolic derivatives of said metabolite classes; comparing the quantifying data obtained on said molecules in said test subject with reference data obtained from the analysis of a plurality of OC-negative humans; wherein said comparison can be used to determine the probability that the test subject would benefit from such therapy.

In a further embodiment of the present invention there is provided a method for determining the probability that a subject is at risk of developing OC comprising: analyzing a blood sample from an OC asymptomatic subject to obtain quantifying data on all, or a subset of, gamma tocopherols, gamma tocotrienols, or metabolic derivatives of said metabolite classes; comparing the quantifying data obtained on said molecules in said test subject with reference data obtained from the analysis of a plurality of OC-negative humans; wherein said comparison can be used to determine the probability that the test subject is at risk of developing OC.

In a further embodiment of the present invention there is provided a method for monitoring irregularities or abnormalities in the biological pathway or system associated with ovarian cancer comprising: analyzing a blood sample from an test subject of unknown ovarian cancer status to obtain quantifying data on all, or a subset of, gamma tocopherols, gamma tocotrienols, or metabolic derivatives of said metabolite classes; comparing the quantifying data obtained on said molecules in said test subject with reference data obtained from the analysis of a plurality of OC-negative humans;

wherein said comparison can be used to monitoring irregularities or abnormalities in the biological pathways or systems associated with ovarian cancer.

In a further embodiment of the present invention there is provided a method for identifying individuals who respond to a dietary, chemical, or biological therapeutic strategy designed to prevent, cure, or stabilize OC or improve symptoms associated with OC comprising: analyzing one or more blood samples from a test subject either from a single collection or from multiple collections over time to obtain quantifying data on all, or a subset of, gamma tocopherols, gamma tocotrienols, omega-carboxylated gamma tocopherol and gamma tocotrienol, vitamin E-like molecules, or metabolic derivatives of said metabolite classes; comparing the quantifying data obtained on said molecules in said test subject's samples with reference data obtained from said molecules from a plurality of OC-negative humans; wherein said comparison can be used to determine whether the metabolic state of said test subject has improved during said therapeutic strategy.

In a further embodiment of the present invention, there is provided a method for identifying individuals who are deficient in the cellular uptake or transport of vitamin E and related metabolites by the analysis of serum or tissue using various strategies, including, but not limited to: radiolabeled tracer studies, gene expression or protein expression analysis of vitamin E transport proteins, analysis of genomic aberrations or mutations in vitamin E transport proteins, in vivo or ex vivo imaging of vitamin E transport protein levels, antibody-based detection (enzyme-linked immunosorbant assay, ELISA) of vitamin E transport proteins.

This summary of the invention does not necessarily describe all features of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features of the invention will become more apparent from the following description in which reference is made to the appended drawings wherein:

FIG. 1 shows a principal component analysis (PCA) plot of ovarian cancer and normal metabolite profiles of serum samples. FIGURE lA uses the complete metabolomic dataset (1,422 masses), while FIG. 1B uses 424 metabolites, with p<0.05. Each point represents an individual patient sample. Grey points represent ovarian cancer patient samples, and black points represent normal controls. With PCA, samples that cluster near to each other must have similar properties based on the data. Therefore, it is evident from this plot that the ovarian cancer patient population shares common metabolic features, and which are distinct from the control population.

FIG. 2A shows a PCA plot resulting from 37 metabolites that were selected from the table of 424 based upon the following criteria: p<0.0001, ¹³C peaks excluded, and only metabolites detected in analysis mode 1204 (organic, negative APCI). Grey points, ovarian cancer samples; black points, normal controls.

FIG. 2B shows the distribution of patient samples binned according to the PC1 loadings score (the position of the point along the x-axis) from FIG. 2A. This shows that, using the origin of the PCA plot as a cutoff point, two of the 20 ovarian cancer patients (grey) group with the control bins (90% sensitivity), while three of the 25 normal subjects (black) group with the ovarian cancer patients (88% specificity).

FIG. 3 shows a hierarchically clustered metabolite array of the 37 selected metabolites. The samples have been clustered using a Euclidean squared distance metric, while the 37 metabolites have been clustered using a Pearson correlation metric. White cells indicate metabolites with absent intensities, while increasingly darker cells correspond to larger metabolite intensities, respectively. These results mirror the PCA results shown in FIG. 2 (A and B), which indicate that two ovarian cancer samples cluster with the control group, and three controls cluster with the ovarian cancer group. The plot, however, indicates that the entire cluster of molecules is deficient from the serum of the ovarian cancer patients relative to the controls. The detected masses are shown along the left side of the figure, while de-identified patient ID numbers are shown along the top of the figure (grey headers, ovarian cancer; black headers, controls). Cells with darker shades of grey to black represent metabolite signals with higher intensities than white or lightly shaded cells.

FIG. 4 shows a bar graph of the relative intensities of the 37 selected metabolites. The intensity values (±1 s.d.) were derived by rescaling the log(2) transformed intensities of individual metabolites between zero and one. The graph shows that all 37 molecules in the ovarian cancer cohort (grey) are significantly lower in intensity relative to the control cohort (black).

FIG. 5 shows a PCA plot of 20 samples (10 ovarian cancer, 10 controls) that was generated using intensities of 29 of the 37 metabolites rediscovered using full-scan HPLC-coupled time-of-flight (TOF) mass spectrometry of the same extract analyzed previously with the FTMS. The ovarian cancer samples (grey) are shown to cluster perfectly apart from the controls (black), verifying that the markers are indeed present in the extracts and are specific for the presence of ovarian cancer.

FIG. 6 shows a graph of 29 of the 37-metabolite panel, identified in a non-targeted analysis on the TOF mass spectrometer (±1 s.d.). The results verify those observed with the FTMS data, that is, these molecules are significantly lower in intensity in ovarian cancer patients (grey) compared to controls (black).

FIG. 7 shows the extracted mass spectra for the retention time window between 15 and 20 minutes from the HPLC-TOF analysis. This shows the masses detected within this elution time of the HPLC column. The peaks represent an average of the 10 controls (top panel) and 10 ovarian cancers (middle panel). The bottom panel shows the net difference between the top and middle spectra. This clearly shows that peaks in the mass range of approximately 450 to 620 are deficient from the ovarian cancer samples (middle panel) relative to the controls (top panel).

FIG. 8 shows the relative intensities of six of the C28 ovarian markers using the targeted HTS triple-quadrupole method (relative intensity+1−SEM). Controls=289 subjects, ovarian=20 subjects.

FIG. 9 shows the relative intensities of 31 ovarian markers using the targeted HTS triple-quadrupole method. Controls=289 subjects, ovarian=241 new cases (black bars) and the 20 original Seracare cases (white bars). The panel was derived from a combination of molecules in Table 1, 2 and 3.

FIG. 10 shows a training error plot for a shrunken centroid supervised classification algorithm using all masses listed in Table 1. The plot shows that the lowest training error (representing the highest diagnostic accuracy) is achieved with the maximum number of metabolites (listed across the top of the plot), that is, all masses in Table 1 (424 total).

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT

The present invention relates to the diagnosis of ovarian cancer (OC), or the risk of developing OC. The present invention describes the relationship between endogenous small molecules and OC. Specifically, the present invention relates to the diagnosis of OC, or the risk of developing OC, through the measurement of vitamin E isoforms and related metabolites. More specifically, the present invention relates to the relationship between vitamin E-related metabolites in human serum and the implications thereof in OC.

The present invention discloses for the first time clear and unambiguous biochemical changes specifically associated with OC. These findings also imply that the measurement of these biomarkers may provide a universal means of measuring the effectiveness of OC therapies. This would dramatically decrease the cost of performing clinical trials as a simple biochemical test can be used to assess the viability of new therapeutics. Furthermore, one would not have to wait until the tumor progresses or until the patient dies to determine whether the therapy provided any benefit. The use of such a test would enable researchers to determine in months, rather than years, the effectiveness of dose, formulation, and chemical structure modifications of OC therapies.

The present invention relates to a method of diagnosing OC by measuring the levels of specific small molecules present in human serum and comparing them to “normal” reference levels. In one embodiment of the present application there is described a novel method for the early detection and diagnosis of OC and the monitoring the effects of OC therapy.

One method of the present invention uses accurate masses in an FTMS based method. The accurate masses that can be used according to this invention include the masses shown in Table 1, or a subset thereof.

A further method involves the use of a high-throughput screening (HTS) assay developed from a subset of metabolites selected from Table 1 for the diagnosis of one or more diseases or particular health-states. The utility of the claimed method is demonstrated and validated through the development of a HTS assay capable of diagnosing an OC-positive health-state.

The impact of such an assay on OC would be tremendous, as literally everyone could be screened longitudinally throughout their lifetime to assess risk and detect ovarian cancer early. Given that the performance characteristics of the test are representative for the general OC population, this test alone may be superior to any other currently available OC screening method, as it may have the potential to detect disease progression prior to that detectable by conventional methods. The early detection of OC is critical to positive treatment outcome.

The term “vitamin E” collectively refers to eight naturally occurring isoforms, four tocopherols (alpha, beta, gamma, and delta) and four tocotrienols (alpha, beta, gamma, and delta). The predominant form found in western diets is gamma-tocopherol whereas the predominant form found in human serum/plasma is alpha-tocopherol. Tocotrienols are also present in the diet, but are more concentrated in cereal grains and certain vegetable oils such as palm and rice bran oil. Interestingly, it is suggested that tocotrienols may be more potent than tocopherols in preventing cardiovascular disease and cancer (5). This may be attributable to the increased distribution of tocotrienols within lipid membranes, a greater ability to interact with radicals, and the ability to be quickly recycled more quickly than tocopherol counterparts (6). It has been demonstrated that in rat liver microsomes, the efficacy of alpha-tocotrienol to protect against iron-mediated lipid peroxidation was 40 times higher that that of alpha-tocopherol (6). However, measurements in human plasma indicate that trienols are either not detected or present only in minute concentrations (7), due possibly to the higher lipophilicity resulting in preferential bilary excretion (8).

A considerable amount of research related to the discrepancy between the distribution of alpha and gamma tocopherol has been performed on these isoforms. It has been known and reported as early as 1974 that gamma- and alpha-tocopherol have similar intestinal absorption but significantly different plasma concentrations (9). In the Bieri and Evarts study (9), rats were depleted of vitamin E for 10 days and then fed a diet containing an alpha:gamma ratio of 0.5 for 14 days. At day 14, the plasma alpha:gamma ratio was observed to be 5.5. The authors attributed this to a significantly higher turnover of gamma-tocopherol, however, the cause of this increased turnover was unknown. Plasma concentrations of the tocopherols are believed to be tightly regulated by the hepatic tocopherol binding protein. This protein has been shown to preferentially bind to alpha-tocopherol (10). Large increases in alpha-tocopherol consumption result in only small increases in plasma concentrations (11). Similar observations hold true for tocotrienols, where high dose supplementation has been shown to result in maximal plasma concentrations of approximately only 1 to 3 micromolar (12). More recently, Birringer et al (8) showed that although upwards of 50% of ingested gamma-tocopherol is metabolized by human hepatoma HepG2 cells by omega-oxidation to various alcohols and carboxylic acids, less than 3% of alpha-tocopherol is metabolized by this pathway. This system appears to be responsible for the increased turnover of gamma-tocopherol. In this paper, they showed that the creation of the omega COOH from gamma-tocopherol occured at a rate of >50× than the creation of the analogous omega COOH from alpha-tocopherol. Birringer also showed that the trienols are metabolized via a similar, but more complex omega carboxylation pathway requiring auxiliary enzymes (8).

It is likely that the existence of these two structurally selective processes has biological significance. Birringer et al (8) propose that the purpose of the gamma-tocopherol-specific P450 omega hydroxylase is the preferential elimination of gamma-tocopherol/trienol as 2,7,8-trimethyl-2-(beta-carboxy-3′-carboxyethyl)-6-hydroxychroman (gamma-CEHC). We argue, however, that if the biological purpose is simply to eliminate gamma-tocopherol/trienol, it would be far simpler and more energy efficient via selective hydroxylation and glucuronidation. The net biological effect of these two processes, which has not been commented on in the vitamin E literature, is that the two primary dietary vitamin E isoforms (alpha and gamma), upon entering the liver during first-pass metabolism, are shunted into two separate metabolic systems. System 1 quickly moves the most biologically active antioxidant isoform (alpha-tocopherol) into the blood stream to supply the tissues of the body with adequate levels of this essential vitamin. System 2 quickly converts gamma-tocopherol into the omega COOH. In the present invention it is disclosed that significant concentrations of multiple isoforms of gamma-tocopherol/tocotrienol omega COOH are present in normal human serum at all times. We were able to estimate that the concentration of each of these molecules in human serum is in the low micromolar range by measuring cholic acid, an organically soluble carboxylic acid-containing internal standard used in the triple-quadrupole method. This is within the previously reported plasma concentration range of 0.5 to 2 micromolar for γ-tocopherol (approximately 20 times lower than that of alpha-tocopherol) (13) The cumulative total, therefore, of all said novel γ-tocoenoic acids in serum is not trivial, and likely exceeds that of γ-tocopherol itself. None of the other shorter chain length gamma-tocopherol/trienol metabolites described by Birringer et al (8) were detected in the serum. Also, the alpha and gamma tocotrienols were also not detected in the serum of patients used in the studies reported in this work, suggesting that the primary purpose of the gamma-tocopherol/trineol-specific P450 omega hydroxylase is the formation of the omega COOH and not gamma-CEHC. Not to be bound by the correctness of the theory, it is therefore suggested that the various gamma-tocopherol/tocotrienol omega COOH metabolites disclosed in the present application are novel bioactive agents and that they perform specific and necessary biological functions for the maintenance of normal health and for the prevention of disease.

Of relevance is also the fact that it has been shown that mammals are able to convert trienols to tocopherols in vivo (14, 15). Since several of the novel vitamin E-like metabolites disclosed herein contain a semi-saturated phytyl side chain, the possibility of a tocotrienol precursor cannot be excluded.

Just as trienols have been reported to have biological activities separate from the tocopherols (16), gamma-tocopherol has been reported to have biological functions separate and distinct from alpha-tocopherol. For example, key differences between alpha tocopherol and alpha tocotrienol include the ability of alpha tocotrienol to specifically prevent neurodegeneration by regulating specific mediators of cell death (17), the ability of trienols to lower cholesterol (18), the ability to reduce oxidative protein damage and extend life span of C. elegans (19), and the ability to suppress the growth of breast cancer cells (20, 21). Key differences between the gamma and alpha forms of tocopherol include the ability of gamma to decrease proinflammatory eicosanoids in inflammation damage in rats (22) and inhibition of cyclooxygenase (COX-2) activity (23). In Jiang et al (23) it was reported that it took 8-24 hours for gamma-tocopherol to be effective and that arachadonic acid competitively inhibits the suppression activity of gamma-tocopherol. It is hypothesized that the omega COOH metabolites of gamma-tocopherol may be the primary bioactive species responsible for its anti-inflammation activity. The conversion of arachadonic acid into eicosanoids is a critical step in inflammation. It is more conceivable that omega COOH forms of gamma-tocopherol, due to their structural similarities to arachadonic acid, are more potent competitive inhibitors of this formation than native gamma-tocopherol.

In one aspect of this invention there is provided novel gamma-tocopherol/tocotrienol metabolites in human serum. These gamma-tocopherol/trienol metabolites have had the aromatic ring structure reduced. In this aspect of the invention, the gamma-tocopherol/tocotrienol metabolites comprise —OC2H5, —OC4H9, or —OC8H17 moieties attached to the hydroxychroman structure in human serum.

Not wishing to be bound by any particular theory, in the present invention it is hypothesized that the novel metabolites disclosed herein are indicators of vitamin E activity and that the decrease of such metabolites is indicative of one of the following situations:

-   -   a. A hyper-oxidative or metabolic state that is consuming         vitamin E and related metabolites at a rate in excess of that         being supplied by the diet;     -   b. A dietary deficiency or impaired absorption of vitamin E and         related metabolites;     -   c. A dietary deficiency or impaired absorption/epithelial         transport of vitamin E-related metabolites.     -   d. An enzymatic deficiency in cytochrome p450 enzymes, including         but not limited to CYP4F2, responsible for omega carboxylation         of gamma-tocopherol. Such deficiency may comprise a genetic         alteration such as single nucleotide polymorphism (SNP),         translocation or epigenetic modification such as methylation.         Alternatively the deficiency may result from protein         post-translational modification, or lack of activation through         required ancillary factors, or through transcriptional silencing         mediated by promoter mutations or improper transcriptional         complex assembly formation.

In all of the aforementioned related epidemiological studies concerning vitamin E, there is little known about the correlation between gamma tocopherol and OC. At the time of this application, a PubMed search for “Ovarian Cancer” and “Gamma Tocopherol” returned only one publication reporting no change in plasma gamma tocopherol levels between OC patients and controls (24). More recent findings have eluded to a potential inverse association between alpha-tocopherol supplementation and ovarian cancer risk (25). Basic research has shown that alpha tocopherol can inhibit telomerase activity in ovarian cancer cells in vitro, suggesting a potential role in the control of ovarian cancer cell growth. No in vitro effects of gamma tocopherol on ovarian cancer cells has been reported.

Based on the discoveries disclosed in this application, it is contemplated that although dietary deficiencies or deficiencies in specific vitamin E metabolizing enzymes may increase the risk of OC incidence, it is also contemplated that the presence of OC may result in the decrease of vitamin E isoforms and related metabolites. These decreased levels are not likely to be the result of a simple dietary deficiency, as such a strong association would have been previously revealed in epidemiological studies, such as in the study performed by Helzlsouer et al (24).

Based on the discoveries disclosed in this application, it is also contemplated that the decreased levels of vitamin E-like metabolites are not the result of a simple dietary deficiency, but rather impairment in the colonic epithelial uptake of vitamin E and related molecules. This therefore represents a rate-limiting step for the sufficient provision of anti-oxidant capacity to epithelial cells under an oxidative stress load. In this model, the dietary effects of increased iron consumption through red meats, high saturated fat, and decreased fiber (resulting in a decreased iron chelation effect (26)) results in the previously mentioned Fenton-induced free radical propagation, of which sufficient scavenging is dependent upon adequate epithelial levels of vitamin E. Increases in epithelial free radical load, combined with a vitamin E-related transport deficiency, would therefore be reflected by a decrease in vitamin E-like metabolites as anti-oxidants, as well as decreases in the reduced carboxylated isoforms resulting from hepatic uptake and P450-mediated metabolism. It has recently been shown that the uptake of Vitamin E into CaCo-2 colonic epithelial cells is a saturable process, heavily dependent upon a protein-mediated event (27). Because protein transporters are in essence enzymes, and follow typical Michaelis-Menton kinetics, the rate at which vitamin E can be taken up into colonic epithelial cells would reach a maximal velocity (Vmax), which may not be capable of providing a sufficient anti-oxidant protective effect for the development of OC. At some point in time, therefore, increasing rates of oxidative stress above the rate at which vitamin E can be transported from the diet will deplete the endogenous pool.

Discovery and Identification of Differentially Expressed Metabolites in Ovarian Cancer-Positive Versus Normal Healthy Controls

Clinical Samples. In order to determine whether there are biochemical markers of a given health-state in a particular population, a group of patients representative of the health-state (i.e. a particular disease) and a group of “normal” counterparts are required. Biological samples taken from the patients in a particular health-state category can then be compared to equivalent samples taken from the normal population with the objective of identifying differences between the two groups, by extracting and analyzing the samples using various analytical platforms including, but not limited to, FTMS and LC-MS. The biological samples could originate from anywhere within the body, including, but not limited to, blood (serum/plasma), cerebrospinal fluid (CSF), urine, stool, breath, saliva, or biopsy of any solid tissue including tumor, adjacent normal, smooth and skeletal muscle, adipose tissue, liver, skin, hair, kidney, pancreas, lung, colon, stomach, or other.

For the ovarian cancer diagnostic assay described herein, serum samples were obtained from representative populations of healthy ovarian cancer-negative individuals and professionally diagnosed ovarian cancer-positive patients. Throughout this application, the term “serum” will be used, but it will be obvious to those skilled in the art that plasma or whole blood or a sub-fraction of whole blood may also be used in the method. The biochemical markers of ovarian cancer described in the invention were derived from the analysis of 20 serum samples from ovarian cancer positive patients and 25 serum samples from healthy controls. In subsequent validation tests, 539 control samples (not diagnosed with ovarian cancer; 289 subjects using the C28 HTS panel, and another 250 using the 31 molecule HTS panel) and 241 ovarian cancer samples were assessed. All samples were single time-point collections, while 289 ovarian cancer samples were taken either immediately prior to or immediately following surgical resection of a tumor (prior to chemotherapy or radiation therapy). The 250 ovarian subset (shown in FIG. 8) was collected following treatment (chemo, surgery or radiation).

Non-Targeted Metabolomic Strategies.

Multiple non-targeted metabolomics strategies have been described in the scientific literature including NMR (28), GC-MS (29-31), LC-MS, and FTMS strategies (28, 32-34). The metabolic profiling strategy employed for the discovery of differentially expressed metabolites in this application was the non-targeted FTMS strategy invented by Phenomenome Discoveries Inc. (30, 34-37). Non-targeted analysis involves the measurement of as many molecules in a sample as possible, without any prior knowledge or selection of components prior to the analysis. Therefore, the potential for non-targeted analysis to discover novel metabolite biomarkers is high versus targeted methods, which detect a predefined list of molecules. The present invention uses a non-targeted method to identify metabolite components that differ between ovarian cancer-positive and healthy individuals, followed by the development of a high-throughput targeted assay for a subset of the metabolites identified from the non-targeted analysis. However, it would be obvious to anyone skilled in the art that other metabolite profiling strategies could potentially be used to discover some or all of the differentially regulated metabolites disclosed in this application, and that the metabolites described herein, however discovered or measured, represent unique chemical entities that are independent of the analytical technology that may be used to detect and measure them.

Sample Processing.

When a blood sample is drawn from a patient there are several ways in which the sample can be processed. The range of processing can be as little as none (i.e. frozen whole blood) or as complex as the isolation of a particular cell type. The most common and routine procedures involve the preparation of either serum or plasma from whole blood. All blood sample processing methods, including spotting of blood samples onto solid-phase supports, such as filter paper or other immobile materials, are also contemplated by the invention.

Sample Extraction.

The processed blood sample described above is then further processed to make it compatible with the analytical technique to be employed in the detection and measurement of the biochemicals contained within the processed blood sample (in our case, a serum sample). The types of processing can range from as little as no further processing to as complex as differential extraction and chemical derivatization. Extraction methods may include, but are not limited to, sonication, soxhlet extraction, microwave assisted extraction (MAE), supercritical fluid extraction (SFE), accelerated solvent extraction (ASE), pressurized liquid extraction (PLE), pressurized hot water extraction (PHWE), and/or surfactant assisted extraction (PHWE) in common solvents such as methanol, ethanol, mixtures of alcohols and water, or organic solvents such as ethyl acetate or hexane. The preferred method of extracting metabolites for FTMS non-targeted analysis is to perform a liquid/liquid extraction whereby non-polar metabolites dissolve in an organic solvent and polar metabolites dissolve in an aqueous solvent. The metabolites contained within the serum samples used in this application were separated into polar and non-polar extracts through sonication and vigorous mixing (vortex mixing).

Mass Spectrometry Analysis of Extracts.

Extracts of biological samples are amenable to analysis on essentially any mass spectrometry platform, either by direct injection or following chromatographic separation. Typical mass spectrometers are comprised of a source, which ionizes molecules within the sample, and a detector for detecting the ionized particles. Examples of common sources include electron impact, electrospray ionization (ESI), atmospheric pressure chemical ionization (APCI), matrix assisted laser desorption ionization (MALDI), surface enhanced laser desorption ionization (SELDI), and derivations thereof. Common ion detectors can include quadrupole-based systems, time-of-flight (TOF), magnetic sector, ion cyclotron, and derivations thereof.

The present invention will be further illustrated in the following examples.

Example 1 Identification of Differentially Expressed Metabolites

The invention described herein involved the analysis of serum extracts from 45 individuals (20 with ovarian cancer, 25 healthy controls) by direct injection into a FTMS and ionization by either ESI or APCI in both positive and negative modes. The advantage of FTMS over other MS-based platforms is the high resolving capability that allows for the separation of metabolites differing by only hundredths of a Dalton, many which would be missed by lower resolution instruments. Sample extracts were diluted either three or six-fold in methanol:0.1% (v/v) ammonium hydroxide (50:50, v/v) for negative ionization modes, or in methanol:0.1% (v/v) formic acid (50:50, v/v) for positive ionization modes. For APCI, sample extracts were directly injected without diluting. All analyses were performed on a Bruker Daltonics APEX III FTMS equipped with a 7.0 T actively shielded superconducting magnet (Bruker Daltonics, Billerica, Mass.). Samples were directly injected using electrospray ionization (ESI) and atmospheric pressure chemical ionization (APCI) at a flow rate of 600 μL per hour. Ion transfer/detection parameters were optimized using a standard mix of serine, tetra-alanine, reserpine, Hewlett-Packard tuning mix, and the adrenocorticotrophic hormone fragment 4-10. In addition, the instrument conditions were tuned to optimize ion intensity and broad-band accumulation over the mass range of 100-1000 amu according to the instrument manufacturer's recommendations. A mixture of the abovementioned standards was used to internally calibrate each sample spectrum for mass accuracy over the acquisition range of 100-1000 amu.

In total six separate analyses comprising combinations of extracts and ionization modes were obtained for each sample:

Aqueous Extract

1. Positive ESI (analysis mode 1101)

2. Negative ESI (analysis mode 1102)

Organic Extract

3. Positive ESI (analysis mode 1201)

4. Negative ESI (analysis mode 1202)

5. Positive APCI (analysis mode 1203)

6. Negative APCI (analysis mode 1204)

Mass Spectrometry Data Processing. Using a linear least-squares regression line, mass axis values were calibrated such that each internal standard mass peak had a mass error of <1 ppm compared with its theoretical mass. Using XMASS software from Bruker Daltonics Inc., data file sizes of 1 megaword were acquired and zero-filled to 2 megawords. A sinm data transformation was performed prior to Fourier transform and magnitude calculations. The mass spectra from each analysis were integrated, creating a peak list that contained the accurate mass and absolute intensity of each peak. Compounds in the range of 100-2000 m/z were analyzed. In order to compare and summarize data across different ionization modes and polarities, all detected mass peaks were converted to their corresponding neutral masses assuming hydrogen adduct formation. A self-generated two-dimensional (mass vs. sample intensity) array was then created using DISCO VAmetrics™ software (Phenomenome Discoveries Inc., Saskatoon, SK, Canada). The data from multiple files were integrated and this combined file was then processed to determine all of the unique masses. The average of each unique mass was determined, representing the γ-axis. A column was created for each file that was originally selected to be analyzed, representing the x-axis. The intensity for each mass found in each of the files selected was then filled into its representative x,y coordinate. Coordinates that did not contain an intensity value were left blank. Once in the array, the data were further processed, visualized and interpreted, and putative chemical identities were assigned. Each of the spectra were then peak picked to obtain the mass and intensity of all metabolites detected. These data from all of the modes were then merged to create one data file per sample. The data from all 45 samples were then merged and aligned to create a two-dimensional metabolite array in which each sample is represented by a column and each unique metabolite is represented by a single row. In the cell corresponding to a given metabolite sample combination, the intensity of the metabolite in that sample is displayed. When the data is represented in this format, metabolites showing differences between groups of samples (i.e., normal and cancer) can be determined.

Advanced Data Interpretation.

A student's T-test was used to select for metabolites that differ between the normal and the ovarian cancer-positive samples (p<0.05). Four hundred and twenty four metabolites met this criterion (shown in Table 1). These are all features that differ statistically between the two populations and therefore have potential diagnostic utility. The features are described by their accurate mass and analysis mode (1204, organic extract and negative APCI), which together are sufficient to provide the putative molecular formulas and chemical characteristics (such as polarity and putative functional groups) of each metabolite. Table 1 also shows the average biomarker intensities and standard deviations of the intensities in the normal and ovarian samples. A log(2) ratio of the metabolite intensities (normal/ovarian) is shown in the far right column. By definition, since each of the metabolites in Table 1 shows a statistically significant difference (p<0.05) between the ovarian and control populations, each mass alone could be individually used to determine whether the health state of a person is “normal” or “ovarian” in nature. For example, this diagnosis could be performed by determining optimal cut-off points for each of the masses in Table 1, and by comparing the relative intensity of the biomarker in an unknown sample to the levels of the marker in the normal and ovarian population, a likelihood ratio for either being ovarian-positive or normal calculated for the unknown sample. This approach could be used individually for any or all of the masses listed in Table 1. Alternatively, this approach could be used on each mass, and then a combined average likelihood score based upon all the masses used.

Similar approaches to the above example would include any methods that use each or all of the masses to generate an averaged or standardized value representing all measure biomarker intensities for ovarian cancer. For example, the intensity of each mass would be measured, and then either used directly or following a normalization method (such as mean normalization, log normalization, Z-score transformation, min-max scaling, etc) to generate a summed or averaged score. Such sums or averages will differ significantly between the ovarian and normal populations, allowing cut-off scores to be used to predict the likelihood of ovarian cancer or normality in future unclassified samples. The cutoff scores themselves, whether for individual masses or for averages or standardized averages of all the masses in Table 1, can be selected using standard operator-receiver characteristic calculations.

A third example in which all masses listed in Table 1 could be used to provide a diagnostic output would be through the use of either a multivariate supervised or unsupervised classification or clustering algorithms. Similar to those listed below for optimal feature set selection, multivariate classification methods such as principal component analysis (PCA) and hierarchical clustering (HCA) (both unsupervised, ie, the algorithm does not know which samples belong to which disease variable), and supervised methods such as supervised PCA, partial least squared discriminant analysis (PLSDA), logistic regression, artificial neural networks (ANNs), support vector machine (SVMs), Bayesian methods and others (see 38 for review), perform optimally with more features. This is shown in the example in FIG. 10 in which a supervised shrunken centroid approach was used to generate a plot of how many of the masses in Table 1 were required for optimal diagnostic classification. The figure shows that the lowest misclassification rate is achieved with all 424 masses (listed across the top of the figure), and that by increasing the threshold of the algorithm, the use of fewer metabolites results in a higher misclassification rate. Therefore, all 424 masses used collectively together results in the highest degree of diagnostic accuracy.

However, the incorporation and development of 424 signals into a commercially useful assay is impractical, and therefore supervised methods such as those listed above are often employed to determine the fewest number of features required to maintain an acceptable level of diagnostic accuracy. In this application, no supervised training classifiers were used to narrow the list further; rather, the list was reduced to 37 (see Table 2) based on univariate analysis, ¹³C filtering, and mode selection. Any other subset from the 424 masses listed in Table 1 can be used according to the present invention to develop a assay for detecting ovarian cancer. A subset of 30 metabolite markers is listed in Table 35. Furthermore, a subset of 29 metabolite markers is listed in Table 3. Alternatively, several supervised methods also exist, of which any one could have been used to identify an alternative subset of masses, including artificial neural networks (ANNs), support vector machines (SVMs), partial least squares discriminant analysis (PLSDA), sub-linear association methods, Bayesian inference methods, supervised principal component analysis, shrunken centroids, or others (see (38) for review).

Example 2 Discovery of Metabolites Associated with Ovarian Cancer Using a FTMS Non-Targeted Metabolomic Approach

The identification of metabolites that can distinguish ovarian cancer patient serum from healthy control serum began with the generation of comprehensive metabolomic profiles of 20 ovarian cancer patients and 25 controls, as described in Example 1. The full dataset comprised 1,244 sample-specific masses, of which 424 showed p-values of less than 0.05 when the data was log(2) transformed and a student's t-test between the ovarian cancer samples and controls performed (Table 1). Each of these masses is statistically significant in discriminating between the ovarian cancer and control cohorts, and therefore has potential diagnostic utility. In addition any subset of the 424-metabolite markers has potential diagnostic utility. Table 1 shows these masses ordered according to the p-value (with the lowest p-values at the beginning of the table).

A statistical analysis technique called principal component analysis (PCA) was used to examine the variance within a multivariate dataset. This method is referred to as “unsupervised”, meaning that the method is unaware of which samples belong to which cohorts. The output of a PCA analysis is a two or three-dimensional plot that projects a single point for each sample on the plot according to its variance. The more closely together that points cluster, the lower the variance is between the samples, or the more similar the samples are to each other based on the data. In FIG. 1, PCA was first performed on the complete set of 1,244 masses, and the points colored according to disease state. Even with no filtering of masses according to significance or p-value, the PCA plot indicates that there is a strong metabolic signature present that is capable of discriminating the ovarian cancer samples from the controls. To identify the maximum number of masses with statistically significant differences in intensity between the ovarian cancer and control samples, a student's t-test was performed, resulting in 424 metabolites with p-values less than 0.05. The PCA plot in FIG. 1B was generated using these 424 metabolites, which shows more tightly clustered groups, particularly for the control cohort (black). This further shows that the 424 masses not only retain, but improve upon the ability to discriminate between the two groups.

However, the incorporation of all 424 masses with p<0.05 into a routine clinical screening method is not practical. As described above, any number of statistical methods, including both supervised and non-supervised methods, could be used to extract subsets of these 424 masses as optimal diagnostic markers, and various methods would yield slightly different results. A subset of 37 metabolites (see Table 2) was selected from the list of 424 as one potential panel of ovarian cancer screening markers. The 37 metabolites were selected by filtering the data for masses with p-values less than 0.0001, removing all ¹³C isotopes, and excluding metabolites not detected in mode 1204. The list of 37 metabolites are shown in Table 2, and include masses (measured in Daltons) 440.3532, 446.3413, 448.3565, 450.3735, 464.3531, 466.3659, 468.3848, 474.3736, 478.405, 484.3793, 490.3678, 492.3841, 494.3973, 502.4055, 504.4195, 510.3943, 512.4083, 518.3974, 520.4131, 522.4323, 530.437, 532.4507, 534.3913, 538.427, 540.4393, 548.4442, 550.4609, 558.4653, 566.4554, 574.4597, 576.4762, 578.493, 590.4597, 592.4728, 594.4857, 596.5015, 598.5121, where a +/−5 ppm difference would indicate the same metabolite. A PCA plot based solely on these masses, is shown in FIG. 2A, which indicates a high degree of separation between the ovarian cancer and the control samples along the PC1 axis. Since the PC1 axis of this dataset is capturing 80% of the overall variance, the PC1 position of every sample could be used as a diagnostic score for each patient. A distribution of the PC1 scores of every sample for each cohort is shown in FIG. 2B, which shows the number of ovarian cancer samples and controls that have PC1 scores falling within six binned ranges. If the origin of the PCA plot in FIG. 2A is used as a cutoff point, one can see that two of the ovarian cancer patients cluster with the control side of the distribution, while three controls cluster with the ovarian cancer side. This suggests an approximate sensitivity of 90% and specificity of 88%.

The PCA plot does not adequately allow one to visualize the actual intensities of the metabolites responsible for the separation of the clusters. A second statistical method was therefore used, called hierarchical clustering (HCA), to arrange the patient samples into groups based on a Euclidean distance measurements using the said 37 metabolites, which themselves were clustered using a Pearson correlation distance measurement. The resulting metabolite array is shown in FIG. 3, and clearly reiterates the results observed with the PCA analysis, that is, the ovarian cancer and control cohorts are clearly discernable, with two ovarian cancer patients clustering within the control cohort, and three controls clustering within the ovarian cancer cohort. The array itself is comprised of cells representing the log(2) intensity from the FTMS, where white indicates metabolites with zero intensity, and increasing shades of grey indicate metabolites with increasing intensity values, respectively. It is clear that the 37 metabolites are all absent or relatively lower in intensity in the ovarian cancer cohort relative to the controls. The graph in FIG. 4 further illustrates this point by plotting the average log(2) intensity (subsequently scaled between zero and one), of the 37 metabolites (±1 s.d.).

Example 3 Independent Method Confirmation of Discovered Metabolites

The metabolites and their associations with the clinical variables described in Example 1 are further confirmed using an independent mass spectrometry system. Representative sample extracts from each variable group are re-analyzed by LC-MS using an HP 1050 high-performance liquid chromatography (HPLC), or equivalent, interfaced to an ABI Q-Star (Applied Biosystems Inc., Foster City, Calif.), or equivalent, mass spectrometer to obtain mass and intensity information for the purpose of identifying metabolites that differ in intensity between the clinical variables under investigation. This is also a non-targeted approach, which provides retention time indices (time it takes for metabolites to elute off the HPLC column), and allows for tandem MS structural investigation. In this case, to verify that the sample extracts from the ovarian cancer patients and the controls did indeed have differential abundances of said markers, selected extracts from each cohort were analyzed independently using said approach. Of the 37 said metabolites described previously, 29 were detected across a set of 10 ovarian cancer and 10 control samples. A PCA plot based on these 29 masses is shown in FIG. 5. The results suggested that the 29 metabolites (see Table 3), as detected on the TOF MS and include masses (measured in Daltons) 446.3544, 448.3715, 450.3804, 468.3986, 474.3872, 476.4885, 478.4209, 484.3907, 490.3800, 492.3930, 494.4120, 502.4181, 504.4333, 512.4196, 518.4161, 520.4193, 522.4410, 530.4435, 532.4690, 538.4361, 540.4529, 550.4667, 558.4816, 574.4707, 578.5034, 592.4198, 594.5027, 596.5191, 598.5174, where a +/−5 ppm difference would indicate the same metabolite, were clearly differentially expressed, as evidenced by complete separation of the 10 ovarian cancer samples from the 10 controls. A bar graph of the 29 metabolites is shown in FIG. 6, which reaffirms a clear deficiency or reduction of these molecules in the ovarian cancer cohort relative to the controls.

The retention times of the 29 metabolites shown in FIG. 6 ranged between approximately 15 to 18 minutes under the chromatographic conditions. To further illustrate the specificity of molecules eluting within this time window for ovarian cancer, averaged extracted mass spectra between 15 and 20 minutes for the controls, the ovarian cancers, and the net difference between the two cohorts were generated as shown in FIG. 7. By comparing the top panel (controls) to the middle panel (ovarian cancer), it is evident that the peaks are at equal heights in both samples until approximately mass 400 is reached, at which point peaks are clearly detectable in the control group (upper panel), but not in the ovarian cancer subjects (middle panel). The bottom panel illustrates the net difference, which includes the 29 masses that overlap with the 37 identified in the FTMS data.

Example 4 MSMS Fragmentation and Structural Investigation of Selected Ovarian Cancer Metabolite Markers

The following example describes the tandem mass spectrometry analysis of a subset of the ovarian markers. The general principle is based upon the selection and fragmentation of each of the parent ions into a pattern of daughter ions. The fragmentation occurs within the mass spectrometer through a process called collision-induced dissociation, wherein an inert gas (such as argon) is allowed to collide with the parent ion resulting in its fragmentation into smaller components. The charge will then travel with one of the corresponding fragments. The pattern of resulting fragment or “daughter ions” represents a specific “fingerprint” for each molecule. Differently structured molecules (including those with the same formulas) will produce different fragmentation patterns, and therefore represents a very specific way of identifying the molecule. By assigning accurate masses and formulas to the fragment ions, structural insights about the molecules can be determined.

In this example, MSMS analysis was carried out on a subset of 31 ovarian markers (from Tables 2 and 3). The resulting fragment ions for each of the selected parent ions are listed in Tables 4 through 34. The parent ion is listed at the top of each table (as its neutral mass), and the subsequent fragments shown as negatively charged ions [M-H]. The intensity (in counts and percent) is shown in the middle and right columns, respectively. The specific retention time (from the high performance liquid chromatography) is shown at the top of the middle column. The ovarian markers all had retention times under the chromatographic conditions used (see methods below) between 16 and 18 minutes.

Proposed structures based upon interpretation of the fragmentation patterns are summarized in Table 35. Subsequent Tables 36 through 65 list the fragment masses and proposed structures of each fragment for each parent molecule. The masses in the table are given as the nominal detected mass [M-H] and the proposed molecular formula is given for each fragment. In addition, the right-hand column indicates the predicted neutral fragment losses.

Interpretation of the MSMS data revealed that the metabolite markers are structurally related to the gamma-tocopherol form of vitamin E, in that they comprise a chroman ring-like moiety and phytyl side-chain. However, these molecules possess several important differences from gamma tocopherol:

a). omega-carboxylated phytyl sidechains (carboxylation at the terminal carbon position of the phytyl chain).

b). semi-saturated and open chroman ring-like systems

c). increased carbon number due to potential hydrocarbon chain addition to the ring system.

Based on the similarity to gamma-tocopherol and the presence of the omega-carboxyl moieties, the class of novel metabolites was named “gamma-tocoenoic acids.”

HPLC analysis were carried out with a high performance liquid chromatograph equipped with quaternary pump, automatic injector, degasser, and a

Hypersil ODS column (5 μm particle size silica, 4.6 i.d×200 mm) and semi-prep column (5 μm particle size silica, 9.1 i.d×200 mm), with an inline filter. Mobile phase: linear gradient H₂O-MeOH to 100% MeOH in a 52 min period at a flow rate 1.0 ml/min.

Eluate from the HPLC was analyzed using an ABI QSTAR® XL mass spectrometer fitted with an atmospheric pressure chemical ionization (APCI) source in negative mode. The scan type in full scan mode was time-of-flight (TOF) with an accumulation time of 1.0000 seconds, mass range between 50 and 1500 Da, and duration time of 55 min. Source parameters were as follows: Ion source gas 1 (GS1) 80; Ion source gas 2 (GS2) 10; Curtain gas (CUR) 30; Nebulizer Current (NC)-3.0; Temperature 400° C.; Declustering Potential (DP)-60; Focusing Potential (FP)-265; Declustering Potential 2 (DP2)-15. In MS/MS mode, scan type was product ion, accumulation time was 1.0000 seconds, scan range between 50 and 650 Da and duration time 55 min. For MSMS analysis, all source parameters are the same as above, with collision energy (CE) of −35 V and collision gas (CAD, nitrogen) of 5 psi.

Example 5 Targeted Triple-Quadrupole Assay for Selected Ovarian Markers

The following example describes the development of a high-throughput screening (HTS) assay based upon triple-quadrupole mass spectrometry for a subset of the ovarian markers. The preliminary method was initially established to determine the ratio of six of the ovarian 28-carbon containing metabolites to an internal standard molecule added during the extraction procedure. This is similar to the HTS method reported in applicant's co-pending CRC/Ovarian PCT application published on Mar. 22, 2007 (WO 2007/030928). The ability of this method to differentiate between ovarian cancer patients and subjects without ovarian cancer is shown in FIG. 8, where the 20 ovarian cancer subjects used to make the initial discovery are compared to 289 disease-free subjects. The six C28 carbon molecules (neutral masses 450 (C28H50O4), 446 (C28H46O4), 468 (C28H52O5), 448 (C28H48O4), 464 (C28H48O5) and 466 (C28H50O5) were validated to be significantly lower in the serum of the ovarian patients versus the controls. The p-values for each of the molecules are shown in Table 66.

Based upon completion of MSMS analysis of the remaining molecules, a new HTS triple-quadrupole method was developed to analyze a larger subset of the ovarian markers. This expanded triple-quadrupole method measures a comprehensive panel of the gamma Tocoenoic acids, and includes the metabolites listed in Table 67. The method measures the daughter fragment ion of each parent, as well an internal standard molecule (see methods below). The biomarker peak areas are then normalized by dividing by the internal standard peak areas.

The method was then used to validate the reduction of gamma tocoenoic acids in a subsequent independent population of controls and ovarian cancer positive subjects. The graph in FIG. 9 shows the average difference in signal intensity for each of the gamma tocoenoic acids in ovarian cancer patients relative to controls. The cohorts comprised 250 controls (i.e. not diagnosed with ovarian cancer at the time samples were taken, grey bars), and 241 ovarian cancer subjects (black bars). The averages of the original 20 ovarian cancer discovery samples (white bars) are also shown for this method. The results confirm that serum from ovarian cancer patients has low levels of gamma-tocoenoic acids relative to disease-free controls. The p-values for each metabolite (250 controls versus 241 ovarian cancers) are shown for each marker in Table 67 as well as in FIG. 9.

Serum samples are extracted as described for non-targeted FTMS analysis. The ethyl acetate organic fraction is used for the analysis of each sample. 15 uL of internal standard is added (1 ng/mL of (24-¹³C)-Cholic Acid in methanol) to each sample aliquot of 120 uL ethyl acetate fraction for a total volume of 135 uL. The autosampler injects 100 uL of the sample by flow-injection analysis into the 4000QTRAP. The carrier solvent is 90% methanol:10% ethyl acetate, with a flow rate of 360 uL/min into the APCI source.

The MS/MS HTS method was developed on a quadrupole linear ion trap ABI 4000QTrap mass spectrometer equipped with a TurboV™ source with an APCI probe. The source gas parameters were as follows: CUR: 10.0, CAD: 6, NC: −3.0, TEM: 400, GS1: 15, interface heater on. “Compound” settings were as follows: entrance potential (EP): −10, and collision cell exit potential (CXP): −20.0. The method is based on the multiple reaction monitoring (MRM) of one parent ion transition for each metabolite and a single transition for the internal standard. Each of the transitions is monitored for 250 ms for a total cycle time of 2.3 seconds. The total acquisition time per sample is approximately 1 min. The method is similar to that described in the PCT case referred to above (WO 2007/030928), but was expanded to include a larger subset of the molecules as shown in Table 67.

All citations are hereby incorporated by reference.

The present invention has been described with regard to one or more embodiments. However, it will be apparent to persons skilled in the art that a number of variations and modifications can be made without departing from the scope of the invention as defined in the claims.

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TABLE 1 List of 424 masses (measured in Daltons) generated from FTMS analysis of serum from ovarian cancer patients and controls (p < 0.05, student's t-test between ovarian cancer positive and control cohort). Detected Analysis Normal Normal Ovarian Ovarian log(2) ratio Mass Mode P-Value AVG SD AVG SD N/O 492.3841 1204 2.82E−08 2.28 0.63 0.79 0.84 2.87 590.4597 1204 4.23E−08 2.51 0.57 1.13 0.83 2.23 447.3436 1204 4.52E−08 1.17 0.79 0.00 0.00 NA 450.3735 1204 8.20E−08 2.28 0.48 0.92 0.91 2.47 502.4055 1204 9.62E−08 2.11 0.62 0.72 0.84 2.92 484.3793 1204 1.09E−07 1.77 0.70 0.44 0.71 4.03 577.4801 1204 1.10E−07 2.68 0.64 1.16 0.96 2.31 490.3678 1204 1.36E−07 1.67 0.71 0.40 0.63 4.21 548.4442 1204 2.36E−07 1.74 0.67 0.48 0.70 3.65 466.3659 1204 4.01E−07 2.48 0.67 1.00 0.99 2.47 494.3973 1204 4.59E−07 2.43 0.75 0.98 0.90 2.49 576.4762 1204 7.50E−07 4.03 0.73 2.76 0.73 1.46 592.4728 1204 7.99E−07 3.78 0.86 2.06 1.14 1.83 464.3531 1204 8.09E−07 2.33 0.63 1.02 0.90 2.30 467.3716 1204 1.37E−06 0.97 0.72 0.05 0.20 21.42  448.3565 1204 1.46E−06 2.30 0.62 1.08 0.85 2.14 574.4597 1204 1.58E−06 3.68 0.84 2.26 0.87 1.63 594.4857 1204 1.65E−06 4.95 0.90 3.34 1.04 1.48 595.4889 1204 1.84E−06 3.64 0.85 1.85 1.32 1.97 594.4878 1202 1.92E−06 3.15 0.94 1.47 1.10 2.14 518.3974 1204 2.04E−06 2.52 0.73 1.15 0.95 2.20 574.4638 1202 2.17E−06 1.65 0.88 0.41 0.56 4.00 504.4195 1204 2.42E−06 1.87 0.70 0.67 0.77 2.79 534.3913 1204 2.52E−06 1.05 0.72 0.11 0.34 9.85 576.4768 1202 2.76E−06 2.07 0.78 0.88 0.67 2.36 519.3329 1101 4.35E−06 2.57 0.57 1.37 0.95 1.88 532.4507 1204 4.62E−06 1.45 0.61 0.48 0.62 2.99 538.4270 1204 6.45E−06 3.63 0.76 2.22 1.09 1.64 566.4554 1204 7.29E−06 1.44 0.89 0.27 0.57 5.34 440.3532 1204 7.63E−06 0.92 0.73 0.05 0.24 17.30  520.4131 1204 8.72E−06 2.72 0.71 1.51 0.90 1.81 596.5015 1204 1.14E−05 5.56 1.05 3.91 1.18 1.42 597.5070 1202 1.20E−05 2.33 1.07 0.85 0.90 2.75 530.4370 1204 1.38E−05 1.65 0.79 0.52 0.75 3.21 541.3148 1101 1.46E−05 2.53 0.59 1.35 1.02 1.88 510.3943 1204 1.47E−05 1.12 0.71 0.22 0.46 5.06 474.3736 1204 1.58E−05 1.53 0.69 0.53 0.69 2.91 575.4631 1204 1.58E−05 2.32 0.96 0.97 0.87 2.38 578.4930 1204 1.66E−05 3.82 0.77 2.53 1.02 1.51 512.4083 1204 1.74E−05 2.34 1.08 0.91 0.85 2.57 597.5068 1204 1.76E−05 4.16 1.01 2.46 1.35 1.69 522.4323 1204 1.88E−05 2.84 0.76 1.71 0.81 1.66 478.4050 1204 1.93E−05 0.88 0.65 0.11 0.34 8.31 596.5056 1202 2.19E−05 3.58 1.14 1.93 1.16 1.85 593.4743 1204 2.28E−05 2.26 1.13 0.77 0.94 2.94 468.3848 1204 2.45E−05 3.14 0.78 1.94 0.93 1.62 598.5121 1204 2.53E−05 2.01 1.13 0.55 0.88 3.64 558.4653 1204 2.79E−05 4.36 0.61 3.40 0.78 1.29 550.4609 1204 3.35E−05 2.10 0.73 0.94 0.95 2.22 559.4687 1204 3.35E−05 2.94 0.60 1.86 0.96 1.58 578.4909 1202 3.86E−05 1.66 0.88 0.59 0.63 2.83 783.5780 1101 4.45E−05 3.92 0.46 3.11 0.73 1.26 850.7030 1203 4.45E−05 3.38 0.60 2.17 1.15 1.56 540.4393 1204 4.81E−05 3.41 0.96 2.08 1.01 1.64 446.3413 1204 4.92E−05 3.08 0.80 1.93 0.93 1.60 482.3605 1204 0.0001 0.81 0.70 0.08 0.37 9.71 521.4195 1204 0.0001 1.20 0.82 0.30 0.54 4.05 524.4454 1204 0.0001 1.06 0.81 0.18 0.47 5.79 540.4407 1202 0.0001 1.56 0.83 0.58 0.62 2.71 541.4420 1204 0.0001 1.96 0.80 0.89 0.84 2.20 579.4967 1204 0.0001 2.53 0.86 1.34 1.03 1.90 580.5101 1204 0.0001 2.41 0.78 1.31 0.95 1.84 610.4853 1204 0.0001 2.18 0.73 1.07 1.01 2.03 616.4670 1201 0.0001 1.50 0.91 0.42 0.70 3.59 749.5365 1202 0.0001 3.85 0.45 2.99 0.88 1.29 750.5403 1202 0.0001 2.82 0.44 1.89 0.98 1.49 784.5813 1101 0.0001 2.83 0.45 2.08 0.68 1.36 785.5295 1204 0.0001 3.02 0.36 2.46 0.49 1.23 814.5918 1202 0.0001 2.54 0.39 2.05 0.38 1.24 829.5856 1102 0.0001 4.40 0.50 3.61 0.74 1.22 830.5885 1102 0.0001 3.29 0.51 2.54 0.67 1.29 830.6539 1102 0.0001 2.48 0.35 1.86 0.60 1.33 851.7107 1203 0.0001 3.03 0.57 1.79 1.28 1.69 244.0560 1101 0.0002 1.52 1.13 2.76 0.82 0.55 306.2570 1204 0.0002 3.11 0.39 2.64 0.40 1.18 508.3783 1204 0.0002 0.97 0.78 0.18 0.43 5.55 513.4117 1204 0.0002 0.87 0.84 0.07 0.29 13.31  521.3479 1101 0.0002 2.32 0.38 1.50 0.90 1.55 536.4105 1204 0.0002 2.57 0.68 1.65 0.83 1.56 565.3393 1102 0.0002 4.16 0.48 3.36 0.83 1.24 570.4653 1203 0.0002 2.21 0.39 1.48 0.81 1.50 618.4836 1201 0.0002 1.50 1.04 0.42 0.69 3.59 757.5016 1204 0.0002 3.95 0.42 3.32 0.63 1.19 784.5235 1204 0.0002 3.74 0.35 3.21 0.51 1.16 852.7242 1204 0.0002 3.64 0.62 2.86 0.65 1.27 317.9626 1101 0.0003 0.85 1.21 2.20 1.03 0.39 523.3640 1101 0.0003 2.51 0.44 1.73 0.88 1.45 546.4305 1204 0.0003 0.80 0.80 0.07 0.30 12.16  555.3101 1102 0.0003 1.93 0.48 1.15 0.84 1.68 577.4792 1202 0.0003 0.73 0.68 0.09 0.27 8.52 726.5454 1204 0.0003 2.78 0.37 1.95 0.98 1.43 568.4732 1204 0.0004 2.00 1.01 0.88 0.95 2.27 824.6890 1203 0.0004 2.33 0.77 1.24 1.13 1.88 469.3872 1204 0.0005 1.04 0.73 0.29 0.59 3.62 534.4644 1204 0.0005 1.32 0.79 0.50 0.65 2.65 723.5198 1202 0.0005 3.06 0.64 2.05 1.13 1.49 886.5582 1102 0.0005 3.50 0.32 2.95 0.65 1.19 897.5730 1102 0.0005 2.26 0.49 1.58 0.72 1.43 226.0687 1102 0.0006 1.93 0.86 2.79 0.65 0.69 531.3123 1102 0.0006 2.38 0.30 1.81 0.70 1.32 558.4666 1202 0.0006 2.35 0.82 1.41 0.89 1.67 566.3433 1102 0.0006 2.43 0.49 1.77 0.71 1.38 569.4783 1204 0.0006 0.94 0.88 0.14 0.43 6.67 595.4938 1202 0.0006 1.56 1.14 0.49 0.67 3.20 876.7223 1203 0.0006 4.38 0.59 3.61 0.81 1.21 518.3182 1101 0.0007 2.39 0.32 1.63 0.98 1.46 537.4151 1204 0.0007 1.15 0.85 0.33 0.60 3.47 545.3460 1101 0.0007 2.45 0.48 1.59 1.04 1.54 552.3825 1201 0.0007 0.00 0.00 0.70 0.97 0.00 557.4533 1204 0.0007 1.47 0.64 0.70 0.78 2.10 572.4472 1204 0.0007 1.59 0.80 0.73 0.77 2.18 581.5130 1204 0.0007 0.96 0.80 0.20 0.50 4.69 699.5206 1204 0.0007 2.58 0.74 1.54 1.16 1.68 750.5434 1204 0.0007 3.83 0.57 2.86 1.16 1.34 787.5446 1204 0.0007 3.16 0.33 2.73 0.45 1.16 826.7051 1203 0.0007 4.43 0.61 3.65 0.83 1.21 596.4792 1203 0.0008 3.36 0.42 2.77 0.66 1.21 675.6358 1203 0.0008 3.37 0.37 2.80 0.67 1.20 727.5564 1204 0.0008 3.65 0.50 2.81 1.02 1.30 770.5108 1204 0.0008 3.19 0.41 2.53 0.79 1.26 506.3212 1202 0.0009 2.55 0.29 2.20 0.36 1.16 728.5620 1204 0.0009 2.99 0.36 2.35 0.80 1.27 813.5889 1202 0.0009 3.51 0.45 3.05 0.40 1.15 647.5740 1203 0.001 2.72 0.58 1.86 1.03 1.46 725.5376 1204 0.001 3.21 0.84 2.11 1.24 1.52 327.0325 1204 0.0011 2.59 0.31 2.01 0.76 1.29 496.3360 1101 0.0011 2.65 0.34 1.99 0.86 1.33 591.3542 1202 0.0011 4.23 0.45 3.74 0.48 1.13 648.5865 1203 0.0011 5.73 0.44 5.00 0.92 1.14 676.6394 1203 0.0011 2.24 0.36 1.50 0.99 1.49 805.5606 1101 0.0011 3.98 0.45 3.38 0.71 1.18 827.7086 1203 0.0011 3.70 0.60 2.85 1.01 1.30 887.5625 1102 0.0011 2.58 0.37 2.01 0.72 1.29 1016.9298 1203 0.0011 4.91 0.63 3.75 1.52 1.31 517.3148 1101 0.0012 4.35 0.36 3.61 0.98 1.20 551.4658 1204 0.0012 0.75 0.71 0.13 0.40 5.81 724.5245 1204 0.0012 3.42 0.69 2.44 1.19 1.40 755.4866 1204 0.0012 3.51 0.38 2.98 0.65 1.18 830.5894 1202 0.0012 4.90 0.49 4.36 0.55 1.12 854.5886 1102 0.0012 2.02 0.46 1.36 0.80 1.48 567.3548 1102 0.0013 3.40 0.41 2.81 0.73 1.21 853.5853 1102 0.0013 2.99 0.48 2.41 0.67 1.24 593.4734 1202 0.0014 0.50 0.65 0.00 0.00 NA 723.5193 1204 0.0014 4.46 0.77 3.33 1.42 1.34 1017.9341 1203 0.0014 4.56 0.65 3.46 1.43 1.32 649.5898 1203 0.0015 4.69 0.48 3.99 0.88 1.18 560.4799 1203 0.0016 2.71 0.37 2.14 0.73 1.26 751.5529 1202 0.0016 3.98 0.52 3.23 0.95 1.23 481.3171 1102 0.0017 1.78 0.36 1.28 0.63 1.39 556.4504 1204 0.0017 2.83 0.42 2.35 0.54 1.20 646.5709 1203 0.0017 3.54 0.60 2.80 0.87 1.26 749.5402 1204 0.0017 4.98 0.64 3.92 1.41 1.27 794.5128 1204 0.0017 2.48 0.32 1.77 1.00 1.40 821.5717 1102 0.0017 3.01 0.44 2.49 0.60 1.21 829.5859 1202 0.0017 6.00 0.50 5.48 0.54 1.09 840.6067 1202 0.0017 2.94 0.33 2.61 0.31 1.12 496.4165 1204 0.0018 2.10 0.90 1.21 0.88 1.74 729.5726 1204 0.0018 2.36 0.38 1.74 0.84 1.36 807.5762 1101 0.0018 4.21 0.41 3.68 0.66 1.15 819.5553 1102 0.0018 2.19 0.64 1.45 0.84 1.51 626.5286 1203 0.0019 3.78 0.36 3.43 0.35 1.10 857.6171 1102 0.0019 2.51 0.80 1.57 1.11 1.60 808.5794 1101 0.002 3.22 0.40 2.69 0.68 1.20 852.7196 1203 0.002 5.94 0.62 5.28 0.72 1.13 505.3227 1202 0.0021 4.06 0.30 3.72 0.38 1.09 566.3433 1202 0.0021 5.29 0.31 4.95 0.37 1.07 592.3570 1202 0.0021 2.46 0.44 1.99 0.53 1.24 541.3422 1102 0.0023 4.44 0.36 3.85 0.83 1.15 542.3452 1102 0.0023 2.64 0.35 2.07 0.79 1.28 779.5438 1101 0.0023 5.08 0.46 4.51 0.74 1.13 785.5936 1101 0.0023 4.21 0.41 3.74 0.56 1.13 786.5403 1204 0.0023 4.16 0.34 3.78 0.44 1.10 758.5654 1101 0.0024 4.35 0.44 3.83 0.63 1.14 1018.9433 1203 0.0024 4.22 0.70 2.91 1.88 1.45 495.3328 1101 0.0025 4.19 0.37 3.51 0.98 1.20 735.6555 1204 0.0025 4.05 0.42 3.45 0.80 1.17 752.5564 1202 0.0025 2.90 0.51 2.17 0.97 1.33 382.1091 1101 0.0026 0.22 0.55 0.85 0.79 0.25 569.3687 1102 0.0027 3.11 0.41 2.48 0.89 1.26 757.5618 1101 0.0027 5.38 0.44 4.87 0.64 1.11 837.5885 1202 0.0027 2.70 0.38 2.33 0.40 1.16 879.7420 1203 0.0027 5.51 0.59 4.89 0.70 1.13 300.2099 1204 0.0028 1.80 0.33 1.27 0.75 1.42 794.5423 1102 0.0029 2.56 0.33 2.05 0.72 1.25 806.5644 1101 0.0029 3.00 0.47 2.47 0.65 1.21 877.7269 1203 0.0029 3.56 0.64 2.79 0.99 1.28 522.4640 1203 0.0031 4.68 0.96 3.73 1.07 1.25 589.3401 1102 0.0031 2.72 0.42 2.18 0.72 1.25 320.2358 1204 0.0032 1.83 0.55 1.22 0.76 1.50 339.9964 1101 0.0032 1.92 0.94 2.87 1.11 0.67 559.4699 1202 0.0032 1.18 0.82 0.47 0.67 2.49 878.7381 1203 0.0032 6.24 0.60 5.65 0.68 1.11 749.5354 1201 0.0033 2.10 0.62 1.38 0.94 1.53 783.5139 1204 0.0033 3.72 0.31 3.33 0.52 1.12 243.0719 1101 0.0034 4.50 0.79 5.24 0.81 0.86 803.5437 1101 0.0035 3.78 0.45 3.17 0.84 1.19 812.5768 1202 0.0035 2.23 0.47 1.69 0.69 1.32 1019.9501 1203 0.0035 3.37 0.70 2.31 1.54 1.46 829.5596 1101 0.0036 2.09 0.47 1.49 0.83 1.40 831.5997 1102 0.0036 5.11 0.51 4.55 0.70 1.12 523.4677 1203 0.0037 3.27 0.93 2.29 1.22 1.43 780.5473 1101 0.0038 3.99 0.47 3.44 0.73 1.16 853.7250 1203 0.0038 5.25 0.62 4.65 0.70 1.13 899.5874 1102 0.0038 2.92 0.51 2.38 0.67 1.23 205.8867 1101 0.0041 2.79 0.28 3.04 0.28 0.92 519.3320 1201 0.0041 2.64 0.73 1.97 0.73 1.34 825.5544 1202 0.0041 3.04 0.86 2.26 0.85 1.34 562.5001 1204 0.0042 2.82 0.51 2.23 0.79 1.26 194.0804 1203 0.0044 0.72 0.80 0.13 0.39 5.63 273.8740 1101 0.0044 2.73 0.29 3.01 0.33 0.91 752.5579 1204 0.0044 4.10 0.67 3.19 1.32 1.29 570.3726 1202 0.0046 3.16 0.23 2.94 0.27 1.08 783.5783 1201 0.0046 6.25 0.37 5.89 0.42 1.06 283.9028 1101 0.0047 3.11 0.33 3.39 0.30 0.92 552.4048 1204 0.0047 0.73 0.70 0.19 0.47 3.91 763.5158 1202 0.0048 1.79 0.77 2.51 0.85 0.71 781.5612 1101 0.0049 4.88 0.41 4.41 0.65 1.11 779.5831 1204 0.005 2.60 0.50 1.94 0.96 1.34 817.5377 1102 0.0052 2.40 0.39 1.92 0.70 1.25 259.9415 1101 0.0053 2.95 0.47 2.30 0.97 1.28 612.5005 1204 0.0053 1.82 0.69 1.13 0.90 1.62 763.5144 1201 0.0053 1.44 0.66 2.13 0.92 0.67 770.5701 1204 0.0053 2.92 0.39 2.34 0.89 1.25 863.6872 1204 0.0053 5.33 0.40 4.90 0.58 1.09 509.3493 1202 0.0054 2.58 0.26 2.31 0.35 1.11 782.5087 1204 0.0055 4.09 0.36 3.73 0.48 1.10 552.4788 1204 0.0056 1.76 0.85 1.00 0.91 1.77 832.6027 1102 0.0057 3.97 0.51 3.44 0.71 1.15 782.5649 1101 0.0058 3.80 0.42 3.33 0.67 1.14 822.5750 1102 0.0058 2.00 0.44 1.55 0.60 1.29 828.5734 1102 0.0058 3.71 0.37 3.19 0.78 1.16 923.5882 1102 0.0058 1.94 0.42 1.44 0.73 1.35 793.5386 1102 0.0059 3.63 0.39 3.20 0.61 1.14 501.3214 1201 0.0061 2.49 0.43 2.13 0.39 1.17 777.5679 1204 0.0062 2.94 0.51 2.28 0.99 1.29 368.1653 1102 0.0064 0.97 1.17 0.16 0.50 6.00 809.5938 1101 0.0064 3.48 0.37 3.08 0.55 1.13 751.5548 1204 0.0065 5.22 0.72 4.38 1.25 1.19 804.5470 1101 0.0065 2.79 0.43 2.30 0.71 1.21 569.3691 1202 0.0066 5.05 0.23 4.82 0.30 1.05 568.3574 1102 0.0068 1.52 0.48 1.07 0.58 1.42 827.5698 1102 0.0068 4.74 0.39 4.21 0.82 1.13 786.5967 1101 0.007 3.12 0.38 2.73 0.54 1.14 753.5669 1204 0.0073 2.92 0.55 2.24 1.06 1.31 759.5159 1204 0.0073 5.19 0.34 4.84 0.49 1.07 855.6012 1102 0.0074 4.13 0.41 3.63 0.76 1.14 858.7902 1101 0.0074 0.06 0.20 0.32 0.41 0.18 756.4904 1204 0.0075 2.65 0.35 2.20 0.72 1.21 580.5345 1203 0.0077 2.21 0.71 1.51 0.97 1.46 784.5808 1201 0.0077 5.30 0.38 4.96 0.45 1.07 853.5864 1202 0.0078 4.92 0.53 4.44 0.63 1.11 560.4828 1204 0.0079 3.80 0.52 3.21 0.88 1.18 573.4855 1203 0.0079 4.39 0.35 4.06 0.46 1.08 587.3229 1202 0.0079 2.10 0.91 1.41 0.72 1.50 560.4816 1202 0.0081 2.02 0.55 1.38 0.96 1.46 952.7568 1203 0.0081 0.91 1.05 0.20 0.50 4.46 801.5551 1202 0.0082 2.59 0.56 2.11 0.59 1.23 741.5306 1204 0.0083 2.93 0.52 2.47 0.59 1.18 773.5339 1204 0.0083 3.58 0.28 3.07 0.87 1.17 854.5903 1202 0.0084 3.98 0.54 3.50 0.63 1.14 847.5955 1202 0.0085 2.55 0.48 2.13 0.54 1.20 736.6583 1204 0.0087 2.92 0.45 2.45 0.69 1.19 529.3167 1202 0.0088 3.21 0.32 2.88 0.48 1.11 810.5401 1204 0.0091 3.49 0.34 3.17 0.45 1.10 628.5425 1203 0.0092 3.22 0.45 2.86 0.40 1.12 518.4345 1203 0.0093 1.33 1.08 0.48 1.00 2.79 769.5644 1204 0.0093 4.01 0.39 3.62 0.57 1.11 990.8090 1204 0.0094 0.00 0.00 0.68 1.25 0.00 269.9704 1101 0.0095 3.86 0.62 3.27 0.85 1.18 804.7219 1203 0.0095 2.47 1.05 1.54 1.23 1.60 216.0401 1102 0.0097 3.01 0.84 3.64 0.69 0.83 300.2084 1202 0.0097 0.27 0.65 0.98 1.07 0.28 411.3186 1202 0.0097 2.88 0.29 2.49 0.64 1.16 746.5561 1102 0.0097 2.01 0.30 1.63 0.62 1.23 632.5753 1203 0.0098 1.46 0.85 0.77 0.85 1.90 895.5578 1102 0.0099 2.60 0.38 2.19 0.64 1.19 688.5294 1204 0.01 2.88 0.42 2.11 1.34 1.36 382.2902 1204 0.0101 0.04 0.18 0.38 0.61 0.09 758.5088 1204 0.0102 4.91 0.36 4.59 0.45 1.07 776.6068 1202 0.0102 1.71 0.63 2.16 0.44 0.79 609.3242 1102 0.0103 2.03 0.35 1.64 0.61 1.24 392.2940 1204 0.0107 1.78 0.95 0.85 1.40 2.10 747.5204 1202 0.0108 2.53 0.55 1.95 0.90 1.30 218.0372 1102 0.0113 1.34 0.77 1.96 0.79 0.68 811.5733 1202 0.0113 3.14 0.52 2.74 0.46 1.14 826.5577 1202 0.0113 2.01 0.88 1.36 0.74 1.48 265.8423 1101 0.0115 2.57 0.64 2.98 0.32 0.86 675.6374 1204 0.0115 3.87 0.48 3.45 0.59 1.12 570.4914 1204 0.0116 0.66 0.79 0.15 0.38 4.35 202.0454 1101 0.0118 2.55 1.09 3.38 1.00 0.76 856.6046 1102 0.0119 3.13 0.41 2.64 0.82 1.19 276.2096 1204 0.012 2.74 0.46 2.34 0.56 1.17 328.2629 1204 0.0121 1.73 0.25 1.94 0.30 0.89 702.5675 1101 0.0121 2.84 0.29 2.48 0.61 1.15 803.5684 1102 0.0122 5.99 0.46 5.54 0.70 1.08 804.5716 1102 0.0122 4.70 0.43 4.27 0.67 1.10 624.5134 1203 0.0127 4.04 0.39 3.72 0.44 1.09 721.6387 1204 0.0129 5.24 0.49 4.79 0.67 1.09 247.9576 1202 0.0132 0.00 0.00 0.94 1.82 0.00 440.3898 1204 0.0138 0.31 0.55 0.00 0.00 NA 926.7366 1203 0.014 2.14 0.97 1.38 0.99 1.55 839.6034 1202 0.0141 3.87 0.36 3.60 0.34 1.07 764.5187 1204 0.0143 1.87 1.08 2.65 0.94 0.71 722.6422 1204 0.0149 4.15 0.51 3.70 0.68 1.12 900.5895 1102 0.0149 1.93 0.46 1.49 0.70 1.29 590.3429 1202 0.015 4.26 0.37 3.95 0.43 1.08 724.5498 1101 0.0151 2.42 0.29 2.01 0.73 1.20 769.4958 1204 0.0151 2.99 0.39 2.47 0.92 1.21 857.6185 1202 0.0155 4.05 0.58 3.57 0.69 1.13 777.5299 1201 0.0156 2.02 0.62 1.61 0.44 1.26 333.8296 1101 0.0158 2.74 0.30 2.99 0.38 0.92 755.5476 1201 0.0158 2.81 0.46 2.47 0.42 1.14 313.9966 1101 0.016 1.41 1.13 0.58 1.07 2.43 599.5004 1203 0.016 5.06 0.52 4.62 0.65 1.09 810.5970 1101 0.0162 2.51 0.42 2.14 0.55 1.17 801.5297 1201 0.0166 2.58 0.97 1.96 0.59 1.31 830.5650 1201 0.0166 3.31 0.46 2.99 0.41 1.11 629.5452 1203 0.0169 1.95 0.66 1.41 0.77 1.38 716.4981 1204 0.0169 2.35 0.34 1.82 1.00 1.29 858.6210 1202 0.0175 2.95 0.61 2.42 0.86 1.22 524.4725 1203 0.0177 1.08 0.92 0.47 0.70 2.31 534.4558 1203 0.0177 2.57 1.08 1.70 1.28 1.51 861.5265 1102 0.0177 2.36 0.43 1.97 0.65 1.20 670.5708 1203 0.0178 1.69 0.89 1.02 0.91 1.65 748.5280 1204 0.018 2.78 0.53 2.31 0.76 1.21 520.4502 1203 0.0181 3.69 0.97 2.97 0.99 1.24 686.5125 1204 0.0184 2.47 0.85 1.67 1.33 1.48 690.5471 1204 0.0185 2.33 0.38 1.79 1.01 1.30 625.5163 1203 0.0187 2.86 0.40 2.47 0.68 1.16 859.6889 1202 0.019 1.98 0.46 2.31 0.47 0.85 1251.1152 1203 0.0191 1.62 1.24 0.78 1.02 2.07 763.5150 1204 0.0196 3.00 0.92 3.67 0.95 0.82 269.8081 1102 0.0199 2.29 0.36 2.53 0.27 0.91 829.5620 1201 0.02 4.27 0.47 3.96 0.39 1.08 745.4973 1204 0.0201 3.51 0.29 3.25 0.44 1.08 541.3138 1201 0.0204 2.13 0.93 1.53 0.69 1.39 1019.3837 1102 0.0205 2.30 0.23 2.46 0.19 0.94 627.5306 1203 0.0209 2.52 0.41 2.16 0.61 1.17 354.1668 1202 0.0216 0.00 0.00 0.41 0.86 0.00 695.6469 1204 0.0219 2.52 1.08 1.65 1.38 1.53 707.6257 1204 0.0224 4.24 0.43 3.89 0.58 1.09 641.4915 1204 0.0226 2.16 1.02 1.42 1.09 1.53 772.5269 1204 0.0229 3.69 0.35 3.38 0.52 1.09 444.3598 1203 0.0242 2.08 0.43 1.60 0.90 1.30 720.2576 1204 0.0253 0.00 0.00 0.40 0.86 0.00 709.2595 1202 0.0254 2.70 0.43 2.38 0.49 1.13 738.5448 1102 0.0258 2.74 0.35 2.43 0.56 1.13 761.5839 1201 0.0262 2.97 0.43 3.25 0.37 0.91 831.5750 1101 0.0265 2.84 0.49 2.48 0.58 1.15 672.5865 1203 0.0268 4.47 0.61 3.94 0.93 1.13 895.5590 1202 0.0268 2.22 0.41 1.87 0.64 1.19 247.9579 1102 0.0271 0.00 0.00 0.48 1.04 0.00 589.3404 1202 0.0272 6.13 0.37 5.84 0.49 1.05 572.4818 1203 0.0273 5.79 0.38 5.50 0.45 1.05 673.5892 1203 0.0277 3.66 0.57 3.08 1.10 1.19 880.7526 1203 0.0278 7.31 0.66 6.87 0.61 1.06 772.5857 1204 0.0279 3.31 0.31 3.04 0.48 1.09 881.7568 1203 0.0279 6.55 0.65 6.13 0.60 1.07 747.5233 1204 0.0284 3.88 0.52 3.37 0.96 1.15 215.9155 1101 0.0285 4.99 0.42 5.24 0.30 0.95 521.4524 1203 0.0285 1.97 1.04 1.28 1.01 1.55 341.8614 1101 0.0287 3.31 0.39 3.59 0.42 0.92 768.4945 1204 0.0299 3.79 0.41 3.47 0.54 1.09 598.4961 1203 0.0307 6.34 0.56 5.94 0.65 1.07 430.3083 1204 0.0312 2.07 0.28 1.88 0.27 1.10 494.4343 1203 0.0313 1.92 1.56 0.94 1.35 2.04 912.8233 1102 0.0314 0.05 0.19 0.26 0.41 0.21 343.8589 1101 0.0319 2.37 0.57 2.68 0.33 0.88 416.3670 1204 0.0319 0.81 0.95 0.26 0.64 3.16 802.5328 1201 0.0325 1.64 0.87 1.16 0.49 1.42 278.2256 1204 0.0333 4.92 0.42 4.61 0.54 1.07 775.5534 1202 0.0334 2.47 0.44 2.05 0.80 1.20 767.5455 1201 0.0335 2.36 0.42 2.67 0.52 0.88 217.9125 1101 0.034 3.60 0.38 3.82 0.31 0.94 838.7228 1204 0.0341 2.61 1.02 1.91 1.12 1.37 363.3499 1201 0.0344 0.06 0.32 0.55 1.05 0.12 263.8452 1101 0.0349 2.74 0.30 2.95 0.36 0.93 371.3538 1203 0.0353 3.05 0.27 2.81 0.45 1.08 828.7205 1203 0.0354 5.58 0.56 5.21 0.60 1.07 872.5557 1102 0.0357 2.39 0.44 2.02 0.71 1.19 871.5528 1102 0.0361 3.46 0.46 3.09 0.68 1.12 872.7844 1102 0.0373 0.17 0.35 0.00 0.00 NA 922.8228 1204 0.0373 2.11 1.56 1.11 1.57 1.91 796.5293 1204 0.0375 3.33 0.34 3.07 0.48 1.09 871.5940 1202 0.0381 2.12 0.44 1.80 0.55 1.18 767.5821 1201 0.0382 3.42 0.58 3.07 0.47 1.11 950.7386 1203 0.0383 0.54 0.93 0.07 0.31 7.77 561.4871 1204 0.0385 2.52 0.59 2.06 0.86 1.22 588.3282 1202 0.0388 0.74 0.80 0.31 0.45 2.36 174.1408 1203 0.0392 1.85 0.25 1.57 0.59 1.18 760.5816 1101 0.0393 3.01 0.45 2.71 0.48 1.11 825.5547 1102 0.0402 1.05 0.77 0.63 0.51 1.67 837.7180 1204 0.0408 3.29 0.96 2.62 1.17 1.26 492.4185 1203 0.0413 0.69 0.94 0.19 0.57 3.72 671.5722 1204 0.0415 2.89 0.40 2.42 1.02 1.19 541.3433 1202 0.0417 5.99 0.34 5.80 0.26 1.03 760.5223 1204 0.0418 4.54 0.30 4.32 0.43 1.05 452.2536 1204 0.0421 1.68 0.34 1.32 0.77 1.27 663.5212 1204 0.0422 2.69 0.76 2.09 1.15 1.29 744.4942 1204 0.0422 4.33 0.37 4.06 0.47 1.06 302.2256 1204 0.0424 3.66 0.40 3.37 0.54 1.09 751.5514 1203 0.043 1.39 1.00 0.76 1.02 1.84 775.5531 1204 0.043 3.60 0.52 3.10 1.05 1.16 798.6773 1203 0.043 1.05 1.09 0.40 0.95 2.60 432.3256 1204 0.0434 1.87 0.46 1.51 0.69 1.24 633.3235 1202 0.0439 1.69 0.62 1.28 0.70 1.32 808.5798 1201 0.044 5.31 0.32 5.12 0.27 1.04 615.3540 1202 0.0443 2.52 0.41 2.25 0.49 1.12 857.8044 1101 0.0444 0.12 0.29 0.36 0.47 0.34 858.7341 1202 0.0449 0.16 0.38 0.67 1.17 0.24 804.7208 1204 0.0452 1.64 1.06 1.01 0.97 1.63 874.5514 1201 0.0453 1.32 0.75 0.85 0.78 1.56 300.2676 1204 0.0462 1.24 0.63 0.84 0.66 1.47 756.5512 1201 0.0465 1.64 0.55 1.29 0.60 1.27 369.3474 1203 0.0466 9.26 0.25 9.07 0.39 1.02 305.2439 1204 0.0472 2.75 0.32 2.48 0.53 1.11 660.5006 1204 0.0473 1.36 0.96 0.76 0.98 1.78 748.5721 1102 0.0489 4.55 0.34 4.24 0.67 1.07 309.3035 1201 0.049 0.00 0.00 0.28 0.70 0.00 910.7247 1204 0.0491 3.75 0.73 3.22 1.02 1.16 252.2096 1204 0.0496 1.81 0.33 1.57 0.47 1.15 829.7242 1203 0.0496 4.83 0.55 4.49 0.57 1.08 255.0896 1203 0.0497 0.00 0.00 0.21 0.53 0.00 807.5768 1201 0.0498 6.22 0.32 6.05 0.26 1.03

TABLE 2 List of 37 metabolite subset selected based upon p < 0.0001, ¹³C exclusion and inclusion of only mode 1204 molecules. Detected Analysis Ovarian Controls Mass (Da) Mode P_Value AVG SD AVG SD 1 440.3532 1204 7.56E−06 2.03 1.15 5.22 1.77 2 446.3413 1204 0.0001 2.48 1.57 6.02 2.00 3 448.3565 1204 1.44E−06 2.28 1.36 5.10 1.52 4 450.3735 1204 8.06E−08 1.94 1.11 4.64 1.67 5 464.3531 1204 8.16E−07 2.36 1.43 5.98 2.29 6 466.3659 1204 3.89E−07 2.45 1.22 5.29 1.74 7 468.3848 1204 2.42E−05 2.41 1.35 5.42 1.85 8 474.3736 1204 1.59E−05 1.54 0.89 3.76 1.47 9 478.405 1204 1.91E−05 2.52 1.25 6.16 2.56 10 484.3793 1204 1.12E−07 2.72 1.65 7.04 3.00 11 490.3678 1204 1.37E−07 1.58 0.89 3.64 1.40 12 492.3841 1204 2.80E−08 1.82 0.97 4.00 1.50 13 494.3973 1204 4.55E−07 1.45 0.72 3.52 1.52 14 502.4055 1204 9.88E−08 3.34 1.70 7.21 2.71 15 504.4195 1204 2.43E−06 4.56 2.57 9.74 3.48 16 510.3943 1204 1.50E−05 1.53 0.70 2.92 0.93 17 512.4083 1204 1.75E−05 2.68 1.59 6.36 2.61 18 518.3974 1204 2.02E−06 3.73 1.77 7.93 3.00 19 520.4131 1204 8.77E−06 4.43 2.09 9.42 3.64 20 522.4323 1204 1.88E−05 1.04 0.20 2.19 0.93 21 530.437 1204 1.38E−05 5.17 3.03 12.38 5.45 22 532.4507 1204 4.65E−06 7.60 3.69 18.25 8.62 23 534.3913 1204 2.58E−06 1.11 0.36 2.31 1.00 24 538.427 1204 6.41E−06 1.32 0.68 3.16 1.48 25 540.4393 1204 4.81E−05 1.65 0.98 3.53 1.39 26 548.4442 1204 2.35E−07 2.21 1.32 6.21 3.37 27 550.4609 1204 3.37E−05 1.05 0.24 2.11 0.92 28 558.4653 1204 2.75E−05 1.23 0.49 2.42 1.01 29 566.4554 1204 7.38E−06 5.57 2.97 14.93 8.32 30 574.4597 1204 1.60E−06 5.38 3.71 16.16 9.51 31 576.4762 1204 7.44E−07 1.61 0.83 3.17 1.27 32 578.493 1204 1.66E−05 5.09 3.96 14.56 8.24 33 590.4597 1204 4.26E−08 5.84 3.62 13.99 7.19 34 592.4728 1204 7.85E−07 1.11 0.37 2.02 0.82 35 594.4857 1204 1.68E−06 7.18 4.76 16.02 7.57 36 596.5015 1204 1.12E−05 2.31 1.32 5.96 3.40 37 598.5121 1204 2.50E−05 12.95 9.28 36.87 22.12

TABLE 3 List of 29-metabolite subset detected by TOF MS, based upon the previous subset of 37 metabolites. Detected Mass (Da) 1 484.3907 2 490.3800 3 512.4196 4 540.4529 5 446.3544 6 538.4361 7 518.4161 8 468.3986 9 492.3930 10 448.3715 11 494.4120 12 474.3872 13 450.3804 14 594.5027 15 520.4193 16 596.5191 17 598.5174 18 522.4410 19 574.4707 20 502.4181 21 592.4198 22 478.4209 23 550.4667 24 504.4333 25 476.4885 26 530.4435 27 578.5034 28 532.4690 29 558.4816

MSMS Fragments for Selected Ovarian Cancer Diagnostic Masses

Each table shows the collision energy in voltage, the HPLC retention time in minutes and the percent intensity of the fragment ion. Masses in the title of the table are neutral, while the masses listed under m/z (amu) are [M-H] and correspond to units in Daltons.

TABLE 4 446.4 CE: −35 V 16.4 min m/z (Da) intensity (counts) % intensity 401.3402 10.3333 100 445.3398 8.1667 79.0323 427.3226 4.5 43.5484 83.0509 2.8333 27.4194 223.1752 2.5 24.1935 222.1558 2.1667 20.9677 205.1506 1.8333 17.7419 383.3338 1.8333 17.7419 59.0097 1.6667 16.129 97.0644 1 9.6774 81.0348 0.6667 6.4516 109.0709 0.6667 6.4516 203.1555 0.6667 6.4516 221.1443 0.6667 6.4516 409.2901 0.6667 6.4516 123.0814 0.5 4.8387 177.1904 0.5 4.8387 233.2224 0.5 4.8387 259.2236 0.5 4.8387 428.3086 0.5 4.8387

TABLE 5 448.4 CE: −35 V 16.6 min m/z (Da) intensity (counts) % intensity 403.3581 3.75 100 429.3269 1.75 46.6667 447.362 1.5 40 385.3944 1 26.6667 83.0543 0.75 20 447.1556 0.75 20 111.0912 0.5 13.3333 151.1253 0.5 13.3333 402.4012 0.5 13.3333 411.3049 0.5 13.3333 429.4669 0.5 13.3333 59.0299 0.25 6.6667 69.0397 0.25 6.6667 74.0264 0.25 6.6667 81.0348 0.25 6.6667 187.1241 0.25 6.6667 223.192 0.25 6.6667 279.2183 0.25 6.6667 385.5049 0.25 6.6667 404.3538 0.25 6.6667

TABLE 6 450.4 CE: −35 V 16.7 min m/z (Da) intensity (counts) % intensity 431.3514 19 100 449.3649 15.25 80.2632 405.3885 10 52.6316 387.3718 4.5 23.6842 405.4792 1.5 7.8947 111.0833 1.25 6.5789 413.34 1.25 6.5789 432.4279 1 5.2632 59.0213 0.75 3.9474 71.0502 0.75 3.9474 97.0681 0.75 3.9474 281.2668 0.75 3.9474 406.4473 0.75 3.9474 450.3442 0.75 3.9474 57.0312 0.5 2.6316 83.0646 0.5 2.6316 123.0772 0.5 2.6316 125.0926 0.5 2.6316 181.1546 0.5 2.6316 233.2167 0.5 2.6316

TABLE 7 468.4 CE: −35 V 16.4 min m/z (Da) intensity (counts) % intensity 449.3774 10.5 100 467.3807 7.5 71.4286 187.139 4 38.0952 449.4809 2 19.0476 263.2327 1.5 14.2857 423.3984 1.5 14.2857 141.1375 1.25 11.9048 279.2257 1.25 11.9048 169.1366 1 9.5238 450.4126 1 9.5238 215.188 0.75 7.1429 297.2482 0.75 7.1429 405.3868 0.75 7.1429 468.4527 0.75 7.1429 185.1619 0.5 4.7619 188.1521 0.5 4.7619 213.1552 0.5 4.7619 251.2335 0.5 4.7619 281.2619 0.5 4.7619 113.0926 0.25 2.381

TABLE 8 474.4 CE: −35 V 16.6 min m/z (Da) intensity (counts) % intensity 473.3896 1.8 100 455.3659 1.05 58.3333 85.0314 0.45 25 113.0367 0.45 25 455.4621 0.35 19.4444 57.0519 0.15 8.3333 71.0216 0.15 8.3333 97.0682 0.15 8.3333 117.0187 0.15 8.3333 222.1549 0.15 8.3333 456.416 0.15 8.3333 473.5285 0.15 8.3333 411.3954 0.7 38.8889 429.3674 0.6 33.3333 75.0151 0.5 27.7778 474.3539 0.3 16.6667 474.4194 0.3 16.6667 223.1912 0.2 11.1111 429.4608 0.2 11.1111 59.0166 0.1 5.5556

TABLE 9 476.5 CE: −35 V 16.8 min m/z (Da) intensity (counts) % intensity 475.3847 4.1818 100 457.387 2.9091 69.5652 431.4157 1.5455 36.9565 413.4004 0.8182 19.5652 279.2634 0.4545 10.8696 439.3666 0.3636 8.6957 458.3751 0.3636 8.6957 458.4715 0.3636 8.6957 476.474 0.2727 6.5217 57.0378 0.1818 4.3478 59.0253 0.1818 4.3478 83.0594 0.1818 4.3478 97.0756 0.1818 4.3478 111.0934 0.1818 4.3478 123.0937 0.1818 4.3478 235.2167 0.1818 4.3478 251.2216 0.1818 4.3478 414.401 0.1818 4.3478 432.43 0.1818 4.3478 71.0121 0.0909 2.1739

TABLE 10 478.4 CE: −35 V 17.1 min m/z (Da) intensity (counts) % intensity 477.3923 7.4286 100 459.3884 5.2857 71.1538 433.3986 2 26.9231 415.3951 1.6429 22.1154 478.4099 0.7857 10.5769 433.508 0.5 6.7308 460.4028 0.5 6.7308 125.0717 0.3571 4.8077 281.2682 0.3571 4.8077 97.0682 0.2857 3.8462 111.0815 0.2857 3.8462 434.5091 0.2857 3.8462 59.0224 0.2143 2.8846 123.0979 0.2143 2.8846 223.2193 0.2143 2.8846 416.4057 0.2143 2.8846 434.3839 0.2143 2.8846 435.3703 0.2143 2.8846 441.4307 0.2143 2.8846 477.22 0.2143 2.8846

TABLE 11 484.4 CE: −40 V 15.6 min m/z (Da) intensity (counts) % intensity 315.254 1.8333 100 123.1312 0.8333 45.4545 297.2741 0.8333 45.4545 185.1313 0.6667 36.3636 465.4187 0.6667 36.3636 279.2508 0.5 27.2727 439.4138 0.5 27.2727 483.3989 0.5 27.2727 171.1296 0.3333 18.1818 187.1442 0.3333 18.1818 201.161 0.3333 18.1818 223.1744 0.3333 18.1818 241.2311 0.3333 18.1818 295.2515 0.3333 18.1818 313.2575 0.3333 18.1818 315.3674 0.3333 18.1818 421.3846 0.3333 18.1818 447.3345 0.3333 18.1818 100.8663 0.1667 9.0909 111.1092 0.1667 9.0909

TABLE 12 490.4 CE: −35 V 16.1 min m/z (Da) intensity (counts) % intensity 489.3601 1.1739 100 319.2795 0.413 35.1852 445.3516 0.3696 31.4815 241.1903 0.3478 29.6296 471.3416 0.3478 29.6296 427.3472 0.1957 16.6667 113.1006 0.1739 14.8148 195.121 0.1739 14.8148 223.18 0.1739 14.8148 249.1847 0.1739 14.8148 490.3405 0.1739 14.8148 97.0682 0.1522 12.963 267.2006 0.1522 12.963 345.279 0.1304 11.1111 57.0349 0.1087 9.2593 101.0209 0.1087 9.2593 143.0888 0.1087 9.2593 265.1915 0.1087 9.2593 373.2819 0.1087 9.2593 472.3936 0.1087 9.2593

TABLE 13 492.4 CE: −40 V 16.7 min m/z (Da) intensity (counts) % intensity 241.1845 4.3077 100 249.1966 2.6923 62.5 267.2006 2.4615 57.1429 97.0682 1.8462 42.8571 473.3569 1.3846 32.1429 223.1632 1.1538 26.7857 195.1839 1 23.2143 143.0663 0.9231 21.4286 447.3901 0.9231 21.4286 101.0285 0.8462 19.6429 491.3636 0.8462 19.6429 113.1046 0.7692 17.8571 319.2661 0.6923 16.0714 57.0434 0.5385 12.5 59.0224 0.4615 10.7143 213.1826 0.4615 10.7143 167.1505 0.3846 8.9286 171.1149 0.3846 8.9286 179.188 0.3846 8.9286 193.1595 0.3846 8.9286

TABLE 14 494.4 CE: −35 V 16.7 min m/z (Da) intensity (counts) % intensity 493.3767 3 100 475.3845 2.6667 88.8889 215.1568 1.6667 55.5556 195.1308 1.3333 44.4444 213.1519 1.3333 44.4444 449.4047 1 33.3333 167.144 0.6667 22.2222 171.1421 0.6667 22.2222 241.2352 0.6667 22.2222 267.2011 0.6667 22.2222 279.2433 0.6667 22.2222 297.2703 0.6667 22.2222 307.2744 0.6667 22.2222 431.3748 0.6667 22.2222 493.5185 0.6667 22.2222 494.4362 0.6667 22.2222 113.0902 0.3333 11.1111 141.1351 0.3333 11.1111 151.1484 0.3333 11.1111 197.1653 0.3333 11.1111

TABLE 15 496.2 CE: −35 V 16.9 min m/z (Da) intensity (counts) % intensity 495.4216 12.6667 100 215.1623 8.6667 68.4211 477.4 5.6667 44.7368 197.1548 4.3333 34.2105 279.2559 2.3333 18.4211 297.2573 2 15.7895 169.1737 1.3333 10.5263 213.1683 1.3333 10.5263 433.4433 1.3333 10.5263 171.1077 1 7.8947 451.476 1 7.8947 179.1444 0.6667 5.2632 195.1466 0.6667 5.2632 241.2119 0.6667 5.2632 496.3828 0.6667 5.2632 83.0475 0.3333 2.6316 84.0218 0.3333 2.6316 111.0833 0.3333 2.6316 223.1472 0.3333 2.6316 225.1985 0.3333 2.6316

TABLE 16 502.4 CE: −35 V 17 min m/z (Da) intensity (counts) % intensity 483.3824 1.0435 100 501.4088 0.913 87.5 439.3981 0.7391 70.8333 457.4191 0.5217 50 501.5013 0.2609 25 279.2634 0.1739 16.6667 458.4876 0.1739 16.6667 484.423 0.1739 16.6667 502.4433 0.1739 16.6667 59.0195 0.1304 12.5 109.108 0.1304 12.5 111.0894 0.1304 12.5 123.1229 0.1304 12.5 196.0608 0.1304 12.5 221.1879 0.1304 12.5 222.1716 0.1304 12.5 277.2469 0.1304 12.5 317.3037 0.1304 12.5 440.3981 0.1304 12.5 465.3782 0.1304 12.5

TABLE 17 504.4 CE: −40 V 17.2 min m/z (Da) intensity (counts) % intensity 485.415 5.8947 100 503.4284 4.0526 68.75 441.415 2.5789 43.75 459.4366 1.2105 20.5357 486.4246 0.6842 11.6071 97.0719 0.4211 7.1429 111.0855 0.3684 6.25 467.397 0.3158 5.3571 504.4312 0.3158 5.3571 57.0434 0.2632 4.4643 223.1632 0.2632 4.4643 263.2388 0.2632 4.4643 377.3256 0.2632 4.4643 442.4567 0.2632 4.4643 169.1464 0.2105 3.5714 279.2383 0.2105 3.5714 329.3051 0.2105 3.5714 59.0166 0.1579 2.6786 71.0216 0.1579 2.6786 83.0662 0.1579 2.6786

TABLE 18 512.4 CE: −35 V 16.0 min m/z (Da) intensity (counts) % intensity 315.2675 12 100 511.3975 8.5 70.8333 151.1622 2.3333 19.4444 213.1464 1.8333 15.2778 297.2767 1.5 12.5 493.4184 1.3333 11.1111 195.1361 1 8.3333 279.2433 1 8.3333 511.5163 0.8333 6.9444 512.4081 0.6667 5.5556 141.1351 0.5 4.1667 171.0979 0.5 4.1667 313.2579 0.5 4.1667 467.3898 0.5 4.1667 169.1591 0.3333 2.7778 177.1304 0.3333 2.7778 231.1633 0.3333 2.7778 251.1945 0.3333 2.7778 259.2115 0.3333 2.7778 314.242 0.3333 2.7778

TABLE 19 518.4 CE: −40 V 16.9 min m/z (Da) intensity (counts) % intensity 517.3886 0.8182 100 499.3933 0.5909 72.2222 115.0412 0.4091 50 455.39 0.3636 44.4444 171.1001 0.3182 38.8889 171.1296 0.3182 38.8889 473.4223 0.2727 33.3333 59.0166 0.2273 27.7778 401.3229 0.2273 27.7778 499.494 0.2273 27.7778 113.1046 0.1818 22.2222 389.3725 0.1818 22.2222 437.4015 0.1818 22.2222 481.3541 0.1818 22.2222 71.0152 0.1364 16.6667 111.0855 0.1364 16.6667 125.1095 0.1364 16.6667 203.1412 0.1364 16.6667 223.152 0.1364 16.6667 445.3833 0.1364 16.6667

TABLE 20 520.4 CE: −42 V 16.8 min m/z (Da) intensity (counts) % intensity 501.392 2.2353 100 519.4144 1.3824 61.8421 457.403 0.8235 36.8421 475.4257 0.6176 27.6316 115.0412 0.4118 18.4211 59.0195 0.3529 15.7895 83.0662 0.3529 15.7895 459.3964 0.3529 15.7895 502.4013 0.3529 15.7895 241.1903 0.3235 14.4737 297.2482 0.2647 11.8421 71.0152 0.2353 10.5263 195.1735 0.2353 10.5263 223.1688 0.2353 10.5263 279.232 0.2353 10.5263 447.398 0.2353 10.5263 483.4154 0.2353 10.5263 97.0719 0.2059 9.2105 111.0894 0.2059 9.2105 221.1655 0.2059 9.2105

TABLE 21 522.4 CE: −40 V 16.9 min m/z (Da) intensity (counts) % intensity 521.427 1.375 100 503.4115 1.2917 93.9394 459.4125 0.375 27.2727 241.1903 0.3333 24.2424 477.4415 0.3333 24.2424 503.5295 0.25 18.1818 111.0934 0.2083 15.1515 115.0453 0.2083 15.1515 171.1149 0.2083 15.1515 267.219 0.2083 15.1515 297.2611 0.2083 15.1515 441.4228 0.2083 15.1515 223.1688 0.1667 12.1212 269.248 0.1667 12.1212 271.2537 0.1667 12.1212 279.2383 0.1667 12.1212 485.415 0.1667 12.1212 522.3961 0.1667 12.1212 57.0378 0.125 9.0909 59.0138 0.125 9.0909

TABLE 22 530.4 CE: −40 V 17.5 min m/z (Da) intensity (counts) % intensity 529.4472 1.1563 100 467.4457 0.8125 70.2703 511.4368 0.8125 70.2703 529.5422 0.2188 18.9189 85.0314 0.1563 13.5135 485.4564 0.1563 13.5135 511.5557 0.1563 13.5135 512.4137 0.1563 13.5135 75.0216 0.125 10.8108 468.4608 0.125 10.8108 177.1785 0.0938 8.1081 250.1932 0.0938 8.1081 251.1978 0.0938 8.1081 530.4237 0.0938 8.1081 59.0195 0.0625 5.4054 97.0645 0.0625 5.4054 109.112 0.0625 5.4054 113.0567 0.0625 5.4054 195.1839 0.0625 5.4054 205.2065 0.0625 5.4054

TABLE 23 532.5 CE: −42 V 17.5 min m/z (Da) intensity (counts) % intensity 513.4424 1.375 100 469.4526 1.25 90.9091 531.4531 0.9375 68.1818 195.1315 0.25 18.1818 469.5828 0.25 18.1818 470.4455 0.25 18.1818 111.0855 0.1875 13.6364 181.1331 0.1875 13.6364 251.1978 0.1875 13.6364 487.4436 0.1875 13.6364 514.4552 0.1875 13.6364 532.4142 0.1875 13.6364 59.0138 0.125 9.0909 71.0121 0.125 9.0909 97.0682 0.125 9.0909 113.0647 0.125 9.0909 127.0909 0.125 9.0909 495.4413 0.125 9.0909 513.6126 0.125 9.0909 531.6003 0.125 9.0909

TABLE 24 538.4 CE: −40 V 16.4 min m/z (Da) intensity (counts) % intensity 537.4416 1.6667 100 519.3973 1 60 475.4175 0.6667 40 493.4212 0.4444 26.6667 59.0224 0.3333 20 115.0493 0.3333 20 333.3025 0.3333 20 501.4088 0.3333 20 519.5598 0.3333 20 537.5721 0.3333 20 101.0285 0.2222 13.3333 315.274 0.2222 13.3333 457.395 0.2222 13.3333 538.3471 0.2222 13.3333 538.4516 0.2222 13.3333 71.0216 0.1111 6.6667 143.1157 0.1111 6.6667 171.1493 0.1111 6.6667 179.183 0.1111 6.6667 221.1655 0.1111 6.6667

TABLE 25 540.5 CE: −35 V 16.3 min m/z (Da) intensity (counts) % intensity 315.2675 24.6 100 539.4356 15.6 63.4146 223.1696 2.4 9.7561 179.1896 2.2 8.9431 521.4115 1.8 7.3171 297.2703 1.2 4.878 495.455 1.2 4.878 477.4492 0.8 3.252 539.5664 0.8 3.252 241.1886 0.6 2.439 259.2055 0.6 2.439 316.2614 0.6 2.439 540.395 0.6 2.439 125.1052 0.4 1.626 171.1519 0.4 1.626 225.176 0.4 1.626 257.1789 0.4 1.626 279.2496 0.4 1.626 313.2314 0.4 1.626 314.1621 0.4 1.626

TABLE 26 550.5 CE: −42 V 17.2 min m/z (Da) intensity (counts) % intensity 487.4684 1 100 549.4751 0.9286 92.8571 531.4531 0.7857 78.5714 251.2156 0.5714 57.1429 253.2248 0.5714 57.1429 111.0934 0.4286 42.8571 125.0969 0.4286 42.8571 269.2233 0.4286 42.8571 271.2475 0.4286 42.8571 277.2282 0.4286 42.8571 513.468 0.4286 42.8571 71.0184 0.3571 35.7143 171.1198 0.3571 35.7143 297.2417 0.3571 35.7143 469.477 0.3571 35.7143 115.0815 0.2857 28.5714 279.2759 0.2857 28.5714 295.2709 0.2857 28.5714 433.3751 0.2857 28.5714 505.5026 0.2857 28.5714

TABLE 27 558.5 CE: −35 V 17.8 min m/z (Da) intensity (counts) % intensity 557.4735 34 100 557.5798 3.3333 9.8039 539.4879 2 5.8824 495.48 1.6667 4.902 278.2406 1.3333 3.9216 558.431 1.3333 3.9216 279.2371 1 2.9412 123.1189 0.6667 1.9608 277.2335 0.6667 1.9608 496.433 0.6667 1.9608 513.4368 0.6667 1.9608 127.1074 0.3333 0.9804 155.1198 0.3333 0.9804 221.1331 0.3333 0.9804 279.3563 0.3333 0.9804 373.3606 0.3333 0.9804 522.4406 0.3333 0.9804 555.3219 0.3333 0.9804 557.9876 0.3333 0.9804 558.3246 0.3333 0.9804

TABLE 28 574.5 CE: −42 V 17.0 min m/z (Da) intensity (counts) % intensity 573.4742 1.0571 100 295.2386 0.7143 67.5676 555.4666 0.5714 54.0541 125.1053 0.4857 45.9459 279.2508 0.4857 45.9459 171.1051 0.4571 43.2432 223.1408 0.4286 40.5405 511.4199 0.4 37.8378 157.085 0.3429 32.4324 493.4546 0.3429 32.4324 183.1039 0.2857 27.027 277.2282 0.2571 24.3243 293.2359 0.2571 24.3243 401.3605 0.2286 21.6216 113.0966 0.2 18.9189 293.2102 0.2 18.9189 429.3752 0.2 18.9189 249.2203 0.1714 16.2162 385.3457 0.1714 16.2162 389.3651 0.1714 16.2162

TABLE 29 576.5 CE: −42 V 17.3 min m/z (Da) intensity (counts) % intensity 575.4808 2.9048 100 277.2219 1.4286 49.1803 297.2676 1.4286 49.1803 557.4591 1.2381 42.623 513.4765 0.9524 32.7869 279.2445 0.8095 27.8689 171.11 0.7619 26.2295 183.114 0.5238 18.0328 295.2322 0.5238 18.0328 125.0969 0.4762 16.3934 403.3711 0.4286 14.7541 111.0775 0.381 13.1148 495.458 0.381 13.1148 251.2394 0.3333 11.4754 293.2102 0.3333 11.4754 97.0682 0.2857 9.8361 113.0926 0.2857 9.8361 205.2011 0.2857 9.8361 223.1351 0.2857 9.8361 296.2329 0.2857 9.8361

TABLE 30 578.5 CE: −35 V 16.8 min m/z (Da) intensity (counts) % intensity 113.0287 4.25 100 103.0116 1 23.5294 175.0313 1 23.5294 85.0349 0.75 17.6471 99.0123 0.75 17.6471 75.0119 0.5 11.7647 95.0153 0.5 11.7647 129.0153 0.5 11.7647 497.4489 0.5 11.7647 577.4728 0.5 11.7647 71.0089 0.25 5.8824 87.0021 0.25 5.8824 114.0248 0.25 5.8824 115.0171 0.25 5.8824 117.0105 0.25 5.8824 576.0393 0.25 5.8824

TABLE 31 592.5 CE: −35 V 17.0 min m/z (Da) intensity (counts) % intensity 113.0248 16.1667 100 85.0418 3.3333 20.6186 103.0116 2 12.3711 175.0214 2 12.3711 117.0227 1.6667 10.3093 59.0224 1.3333 8.2474 75.0151 1.3333 8.2474 95.0226 1.3333 8.2474 99.0123 1.3333 8.2474 115.009 1 6.1856 149.0733 1 6.1856 87.0126 0.8333 5.1546 129.0153 0.8333 5.1546 591.4221 0.8333 5.1546 157.0097 0.6667 4.1237 415.3721 0.6667 4.1237 73.0352 0.5 3.0928 415.4945 0.5 3.0928 71.0152 0.3333 2.0619 89.0307 0.3333 2.0619

TABLE 32 594.5 CE: −50 V 16.7 min m/z (Da) intensity (counts) % intensity 371.3397 4.2 100 171.1077 3.6 85.7143 315.2609 3.6 85.7143 575.4927 3.6 85.7143 277.2335 3.4 80.9524 201.1328 3 71.4286 295.2351 2.8 66.6667 297.2832 2.8 66.6667 593.4968 2.8 66.6667 279.2496 2.4 57.1429 557.4646 2.2 52.381 141.1351 1.8 42.8571 313.2513 1.6 38.0952 513.4793 1.6 38.0952 557.438 1.6 38.0952 125.0968 1.4 33.3333 593.57 1.4 33.3333 575.6008 1.2 28.5714 113.0941 1 23.8095 139.1134 1 23.8095

TABLE 33 596.5 CE: −50 V 16.9 min m/z (Da) intensity (counts) % intensity 279.2433 53.6 100 315.2609 35.8 66.791 297.2638 21.6 40.2985 313.2447 9.6 17.9104 577.5116 7.4 13.806 281.2542 6.8 12.6866 595.5011 6.2 11.5672 295.2416 3.6 6.7164 171.1028 3.4 6.3433 515.5056 3.2 5.9701 559.4693 2.6 4.8507 125.101 2.4 4.4776 141.1261 2 3.7313 127.1201 1.8 3.3582 155.1431 1.6 2.9851 169.1249 1.4 2.6119 185.1116 1.4 2.6119 207.2041 1.4 2.6119 280.2479 1.2 2.2388 373.3606 1.2 2.2388

TABLE 34 598.5 CE: −40 V 16.9 min m/z (Da) intensity (counts) % intensity 597.5182 2.6667 100 579.5044 0.6667 25 279.2383 0.5833 21.875 298.2523 0.5833 21.875 316.2614 0.5833 21.875 280.2303 0.4167 15.625 281.2431 0.4167 15.625 314.255 0.4167 15.625 317.2837 0.4167 15.625 315.2474 0.3333 12.5 282.2576 0.25 9.375 297.2417 0.25 9.375 517.4654 0.25 9.375 171.0952 0.1667 6.25 295.2386 0.1667 6.25 296.291 0.1667 6.25 299.2386 0.1667 6.25 313.2243 0.1667 6.25 515.5116 0.1667 6.25 561.5262 0.1667 6.25

TABLE 35 Accurate masses, putative molecular formulae and proposed structures for the thirty ovarian biomarkers detected in organic extracts of human serum. Exact Detected Mass Mass (Da) (Da) Formula Proposed Structure  1 446.3413 446.3396 C₂₈H₄₆O₄

 2 448.3565 448.3553 C₂₈H₄₈O₄

 3 450.3735 450.3709 C₂₈H₅₀O₄

 4 468.3848 468.3814 C₂₈H₅₂O₅

 5 474.3872 474.3736 C₃₀H₅₀O₄

 6 478.405 478.4022 C₃₀H₅₄O₄

 7 484.3793 484.3764 C₂₈H₅₂O₆

 8 490.3678 490.3658 C₃₀H₅₀O₅

 9 492.3841 492.3815 C₃₀H₅₂O₅

10 494.3973 494.3971 C₃₀H₅₄O₅

11 496.4157 496.4128 C₃₀H₅₆O₅

12 502.4055 502.4022 C₃₂H₅₄O₄

13 504.4195 504.4179 C₃₂H₅₆O₄

14 512.4083 512.4077 C₃₀H₅₆O₆

15 518.3974 518.3971 C₃₂H₅₄O₅

16 520.4131 520.4128 C₃₂H₅₆O₅

17 522.4323 522.8284 C₃₂H₆₀O₅

18 530.437 530.43351 C₃₄H₅₈O₄

19 532.4507 532.44916 C₃₄H₆₀O₄

20 538.427 538.42334 C₃₂H₅₈O₆

21 540.4393 540.4389 C₃₂H₆₀O₆

22 550.4609 550.4597 C₃₄H₆₂O₅

23 558.4653 558.4648 C₃₆H₆₂O₄

24 574.4597 574.4597 C₃₆H₆₂O₅

25 576.4757 576.4754 C₃₆H₆₄O₅

26 578.4848 578.4910 C₃₆H₆₆O₅

27 592.357 592.47029 C₃₆H₆₄O₆

28 594.4848 594.4859 C₃₆H₆₆O₆

29 596.5012 596.5016 C₃₆H₆₈O₆

30 598.5121 598.5172 C₃₆H₇₀O₆

Assignment of MS/MS Fragments for Ovarian Cancer Biomarkers

TABLE 36 MS/MS fragmentation of ovarian cancer biomarker 446.3544. m/z (Da) Formula Molecular fragment Fragment loss 445 C₂₈H₄₅O₄

—H⁺ 427 C₂₈H₄₃O₃

—H₂O 401 C₂₇H₄₅O₂

—CO₂ 383 C₂₇H₄₃O

—(CO₂ + H₂O) 223 C₁₄H₂₃O₂

205 C₁₄H₂₁O

177 C₁₂H₁₇O

(g) —C₂H₄ 162 C₁₁H₁₁₄O

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 37 MS/MS fragmentation of ovarian cancer biomarker 448.3715. m/z (Da) Formula Molecular fragment Fragment loss 447 C₂₈H₄₇O₄

—H⁺ 429 C₂₈H₄₅O₃

—H₂O 403 C₂₇H₄₇O₂

—CO₂ 385 C₂₇H₄₅O

—(CO₂ + H₂O) 279 C₁₉H₃₅O

Ring opening of 429 at O1 - C2 and loss of 151 187 C₁₀H₁₉O₃

151 C₁₀H₁₅O

Ring opening of 429 at O1 - C2 and loss of 279 111 C₈H₁₅

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 38 MS/MS fragmentation of ovarian cancer biomarker 450.3804. m/z (Da) Formula Molecular fragment Fragment loss 449 C₂₈H₄₉O₄

—H⁺ 431 C₂₈H₄₉O₄

—H₂O 413 C₂₈H₄₅O₂

-2 x H₂O 405 C₂₇H₄₉O₂

—CO₂ 387 C₂₇H₄₇O

—(CO₂ + H₂O) 309 C₂₀H₃₇O₂

Ring opening at O1 - C2 and, 431 - 125 281 C₁₈H₃₃O₂

181 C₁₁H₁₇O₂

125 C₈H₁₃O

431 - 309 111 C₁₇H₁₁O

125 - CH₂  97 C₆H₉O

111 - CH₂ Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 39 MS/MS fragmentation of ovarian cancer biomarker 468.3986 m/z (Da) Formula Molecular fragment Fragment loss 467 C₂₈H₅₁O₅

—H⁺ 449 C₂₈H₄₉O₄

—H₂O 431 C₂₈H₄₇O₃

-2 x H₂O 423 C₂₇H₅₁O₂

—CO₂ 405 C₂₇H₄₉O₂

—(CO₂ + H₂O) 297 C₁₈H₃₃O₃

281 C₁₈H₃₃O₂

279 C₁₈H₃₁O₂

297 - H₂O 263 C₁₈H₂₉O

281 - H₂O 251 C₁₆H₂₇O₂

281 - C₂H₆ 169 C₁₀H₁₇O₂

Ring opening at O1 - C2 and, - 281 141 C₈H₁₃O₂

169 - C₂H₄ Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 40 MS/MS fragmentation of ovarian cancer biomarker 474.3736. m/z (Da) Formula Molecular fragment Fragment loss 473 C₃₀H₄₉O₄

—H⁺ 455 C₃₀H₄₇O₃

—H₂O 429 C₂₉H₄₉O₂

—CO₂ 411 C₂₉H₄₇O

—(CO₂ + H₂O) 223 C₁₅H₂₇O

113 C₆H₉O₂

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 41 MS/MS fragmentation of ovarian cancer biomarker 478.405 m/z (Da) Formula Molecular fragment Fragment loss 477 C₃₀H₅₃O₄

—H⁺ 460 C₃₀H₅₁O₃

—H₂O 433 C₂₉H₅₃O₂

—CO₂ 415 C₂₉H₅₁O

—(CO₂ + H₂O) 281 C₁₈H₃₃O₂

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 42 MS/MS fragmentation of ovarian cancer biomarker 484.3739. m/z (Da) Formula Molecular fragment Fragment loss 483 C₂₈H₅₁O₆

—H⁺ 465 C₂₈H₄₉O₅

—H₂O 447 C₂₈H₄₇O₄

-2H₂O 439 C₂₇H₅₁O₄

—CO₂ 421 C₂₄H₄₉O₃

—(CO₂ + 2H₂O) 315 C₁₈H₃₅O₄

313 C₁₈H₃₃O₄

297 C₁₈H₃₃O₃

315 − H₂O 279 C₁₈H₃₁O₂

297 − H₂O 241 C₁₄H₂₅O₃

201 C₁₁H₂₁O₃

171 C₁₀H₁₉O₂

Ring opening at O1 − C2 and, −315 101 C₅H₉O₂

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 43 MS/MS fragmentation of ovarian cancer biomarker 490.3678. m/z (Da) Formula Molecular fragment Fragment loss 489 C₃₀H₄₉O₅

—H⁺ 471 C₃₀H₄₇O₄

—H₂O 445 C₂₉H₄₉O₃

—CO₂ 427 C₂₉H₄₇O₂

—(CO₂ + 2H₂O) 373 C₂₅H₄₁O₂

345 C₂₃H₃₇O₂

373 − C₂H₄ 319 C₂₁H₃₅O₂

373 − C₄H₆ 267 C₁₆H₂₇O₃

249 C₁₆H₂₅O₂

223 C₁₄H₂₃O₂

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 44 MS/MS fragmentation of ovarian cancer biomarker 492.3841. m/z (Da) Formula Molecular fragment Fragment loss 491 C₃₀H₅₁O₅

—H⁺ 473 C₃₀H₄₉O₄

—H₂O 445 C₂₉H₅₁O₃

—CO₂ 427 C₂₉H₄₉O₂

—(CO₂ + 2H₂O) 319 C₂₁H₃₅O₂

249 C₁₆H₂₅O₂

241 C₁₄H₂₅O₃

223 C₁₄H₂₃O₂

241 − H₂O 213 C₁₅H₂₄O₂

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 45 MS/MS fragmentation of ovarian cancer biomarker 494.3973. m/z (Da) Formula Molecular fragment Fragment loss 493 C₃₀H₅₃O₅

—H⁺ 475 C₃₀H₅₁O₃

—H₂O 449 C₂₉H₅₃O₃

—CO₂ 431 C₂₉H₅₁O₂

—(CO₂ + H₂O) 415 C₂₉H₅₁O

—(CO₂ + 2H₂O) 307 C₂₀H₃₅O₂

297 C₁₈H₃₃O₃

279 C₁₈H₃₁O₂

297 − H₂O 267 C₁₆H₂₇O₃

241 C₁₄H₂₅O₃

267 − C₂H₂ 235 C₁₆H₂₇O

223 C₁₄H₂₃O₂

215 C₁₂H₂₃O₂

Fragmentation at C13 − C14 and loss of CH₃ 197 C₁₂H₂₁O₂

-phytol chain 167 C₁₀H₁₅O₂

197 − C₂H₆ 151 C₁₀H₁₅O

197 − C₂H₅OH 141 C₉H₁₇O

113 C₆H₉O₂

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 46 MS/MS fragmentation of ovarian cancer biomarker 496.4165. m/z (Da) Formula Molecular fragment Fragment loss 495 C₃₀H₅₅O₅

—H⁺ 477 C₃₀H₅₃O₃

—H₂O 451 C₂₉H₅₅O₃

—CO₂ 433 C₂₉H₅₃O₂

—(CO₂ + H₂O) 297 C₁₈H₃₃O₃

279 C₁₈H₃₁O₂

297 − H₂O 241 C₁₄H₂₅O₃

223 C₁₄H₂₃O₂

241 − H₂O 215 C₁₂H₂₃O₂

Fragmentation at C13 − C14 and loss of CH₃ 197 C₁₂H₂₁O₂

-phytol chain 179 C₁₂H₁₉O

197 − H₂O 169 C₁₀H₁₇O₂

179 − C₂H₄ Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 47 MS/MS fragmentation of ovarian cancer biomarker 502.4055. m/z (Da) Formula Molecular fragment Fragment loss 501 C₃₂H₅₃O₄

—H⁺ 483 C₃₂H₅₁O₃

—H₂O 465 C₃₂H₄₉O₂

-2xH₂O 457 C₃₁H₅₃O₂

—CO₂ 439 C₃₁H₅₁O

—(CO₂ + H₂O) 279 C₁₈H₃₁O₂

Ring opening at O1 − C2 of 483 and detachment of phytol chain Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 48 MS/MS fragmentation of ovarian cancer biomarker 504.4195. m/z (Da) Formula Molecular fragment Fragment loss 503 C₃₂H₅₅O₄

—H⁺ 485 C₃₂H₅₃O₃

—H₂O 467 C₃₂H₅₁O₂

-2xH₂O 459 C₃₁H₅₅O₂

—CO₂ 441 C₃₁H₅₃O

—(CO₂ + H₂O) 279 C₁₈H₃₁O₂

263 C₁₇H₂₇O₂

279 v CH₄ 223 C₁₄H₂₃O₂

263 − C₃H₄ 169 C₁₀H₁₇O₂

223 − C₄H₆ Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 49 MS/MS fragmentation of ovarian cancer biomarker 512.4083. m/z (Da) Formula Molecular fragment Fragment loss 511 C₃₀H₅₅O₆

—H⁺ 493 C₃₀H₅₃O₅

—H₂O 467 C₂₉H₅₅O₄

—CO₂ 315 C₁₈H₃₅O₄

297 C₁₈H₃₃O₃

315 − H₂O 279 C₁₈H₃₁O₂

297 − H₂O 259 C₁₄H₂₇O₄

315 − C₄H₈ 251 C₁₆H₂₇O₂

279 − C₂H₄ 151 C₁₀H₁₅O

Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons.

TABLE 50 MS/MS fragmentation of ovarian cancer biomarker 518.3974. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 517 C₃₂H₅₃O₅

−H⁺ 499 C₃₂H₅₁O₄

−H₂O 481 C₃₂H₄₉O₃

−2 × H₂O 473 C₃₁H₅₃O₃

−CO₂ 455 C₃₁H₅₁O₂

−(CO₂ + H₂O) 445 C₂₉H₄₉O₃

473 − C₂H₄ 437 C₃₁H₄₉O

455 − H₂O 389 C₂₅H₄₁O₃

445 − C₄H₈ 279 C₁₈H₃₁O₂

223 C₁₄H₃₂O₂

Ring opening at O1 − C2 and detachment of the phytol chain

TABLE 51 MS/MS fragmentation of ovarian cancer biomarker 520.4131. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 519 C₃₂H₅₅O₅

—H⁺ 501 C₃₂H₅₃O₄

—H₂O 483 C₃₂H₅₁O₃

-2xH₂O 475 C₃₁H₅₅O₃

—CO₂ 459 C₃₀H₅₁O₃

475 - CH₄ 457 C₃₁H₅₃O₂

—(CO₂ + H₂O) 447 C₂₈H₄₇O₄

—C₄H₈O 297 C₁₈H₃₃O₃

279 C₁₈H₃₁O₂

297 - H₂O 241 C₁₄H₂₅O₃

297 - C₄H₈ 223 C₁₄H₂₃O₂

Ring opening at O1-C2 and detachment of the phytol chain 195 C₁₂H₁₉O₄

223 - C₂H₄ 115 C₆H₁₁O₂

TABLE 52 MS/MS fragmentation of ovarian cancer biomarker 522.4323. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 521 C₃₂H₅₇O₅

−H⁺ 503 C₃₂H₅₅O₅

−H₂O 485 C₃₂H₅₅O₅

−2 × H₂O 477 C₃₁H₅₇O₃

−CO₂ 459 C₃₁H₅₅O₂

−(CO₂ + H₂O) 441 C₃₁H₅₃O

−(CO₂ + 2H₂O) 297 C₁₈H₃₃O₃

279 C₁₈H₃₁O₂

297 − H₂O 269 C₁₆H₂₉O₃

297 − C₂H₄ 241 C₁₄H₂₅O₃

269 − C₂H₄ 115 C₆H₁₁O₂

TABLE 53 MS/MS fragmentation of ovarian cancer biomarker 530.437. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 529 C₃₄H₅₇O₄

−H⁺ 511 C₃₄H₅₅O₃

−H₂O 485 C₃₃H₅₇O₂

−CO₂ 467 C₃₃H₅₅O

−(CO₂ + H₂O) 251 C₁₆H₂₇O₂

205 C₁₅H₂₅

TABLE 54 MS/MS fragmentation of ovarian cancer biomarker 532.4507. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 531 C₃₄H₅₉O₄

−H⁺ 513 C₃₄H₅₇O₃

−H₂O 495 C₃₄H₅₅O₂

−2H₂O 485 C₃₃H₅₉O₂

−CO₂ 469 C₃₃H₅₇O

−(CO₂ + H₂O) 251 C₁₆H₂₇O₂

181 C₁₂H₂₁O

TABLE 55 MS/MS fragmentation of ovarian cancer biomarker 538.427. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 538 C₃₂H₅₇O₆

−H⁺ 519 C₃₂H₅₅O₅

−H₂O 501 C₃₂H₅₃O₄

−2H₂O 493 C₃₁H₅₇O₄

−CO₂ 475 C₃₁H₅₅O₃

−(CO₂ + H₂O) 457 C₃₁H₅₃O₂

−(CO₂ + 2H₂O) 333 C₂₂H₃₇O₂

457 − C₉H1₆ 315 C₁₈H₃₅O₄

TABLE 56 MS/MS fragmentation of ovarian cancer biomarker 540.4390. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 539 C₃₂H₅₉O₆

−H⁺ 521 C₃₂H₅₇O₅

−H₂O 495 C₃₁H₅₉O₄

−CO₂ 477 C₃₁H₅₇O₃

−(CO₂ + H₂O) 315 C₁₈H₃₅O₄

313 C₁₈H₃₃O₄

297 C₁₈H₃₃O₃

315 − H₂O 279 C₁₈H₃₁O₂

297 − H₂O 259 C₁₄H₂₇O₄

243 C₁₄H₂₇O₃

259 − CH₄ 241 C₁₅H₂₉O₂

495 − 253 225 C₁₄H₂₅O₂

−phytol chain 223 C₁₄H₂₃O₂

241 − H₂O 179 C₁₂H₁₉O

253 − C₄H₉OH 171 C₁₀H₁₉O₂

213 − C₃H₆

TABLE 57 MS/MS fragmentation of ovarian cancer biomarker 550.4609. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 549 C₃₄H₆₁O₅

−H⁺ 531 C₃₄H₅₉O₄

−H₂O 513 C₃₄H₅₇O₃

−2H₂O 505 C₃₃H₆₁O₃

−CO₂ 487 C₃₃H₅₉O₂

−(CO₂ + H₂O) 469 C₃₃H₅₇O

−(CO₂ + 2H₂O) 297 C₁₈H₃₃O₃

279 C₁₈H₃₁O₂

297 − H₂O 269 C₁₆H₂₉O₃

253 C₁₆H₂₉O₂

−phytol chain 125 C₉H₁₇

TABLE 58 MS/MS fragmentation of ovarian cancer biomarker 558.4653. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 557 C₃₆H₆₁O₄

−H⁺ 539 C₃₆H₅₉O₄

−H₂O 513 C₃₅H₆₁O₂

−CO₂ 495 C₃₅H₅₉O

−(CO₂ + H₂O) 279 C₁₈H₃₁O₂

279 C₁₈H₃₁O₂

−phytol chain 155 C₉H₁₅O₂

TABLE 59 MS/MS fragmentation of ovarian cancer biomarker 574.4638. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 573 C₃₆H₆₁O₅

−H⁺ 555 C₃₆H₅₉O₄

−H₂O 537 C₃₆H₅₇O₃

−2H₂O 529 C₃₅H₆₁O₃

−CO₂ 511 C₃₅H₅₉O₂

−(CO₂ + H₂O) 493 C₃₅H₅₇O

−(CO₂ + 2H₂O) 401 C₂₇H₄₅O₂

511 − C₈H₁₄ 295 C₁₈H₃₁O₃

279 C₁₈H₃₁O₂

Ring opening at O1 − C2 and loss of phytol chain 279 C₁₈H₃₁O₂

223 C₁₄H₂₃O₂

279 − C₄H₈

TABLE 60 MS/MS fragmentation of ovarian cancer biomarker 576.4762 (C₃₆H₆₄O₅). Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 575 C₃₆H₆₃O₅

−H⁺ 557 C₃₆H₆₁O₄

−H₂O 539 C₃₆H₅₉O₃

−2 × H₂O 531 C₃₅H₆₃O₃

−CO₂ 513 C₃₅H₆₁O₂

557 − CO₂ 495 C₃₅H₅₉O

531 − CO₂ 403 C₂₈H₄₇O₂

495 − C₇H₁₂ 297 C₁₈H₃₃O₃

279 C₁₈H₃₃O₂

279 C₁₈H₃₁O₂

−phytol chain 251 C₁₆H₂₇O₂

183 C₁₁H₁₉O₂

TABLE 61 MS/MS fragmentation of ovarian cancer biomarker 578.493. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 577 C₃₆H₆₅O₅

−H⁺ 559 C₃₆H₆₃O₄

−H₂O 541 C₃₆H₆₁O₃

−2 × H₂O 533 C₃₅H₆₅O₃

−CO₂ 515 C₃₅H₆₃O₂

559 − CO₂ 497 C₃₅H₆₁O

533 − CO₂ 373 C₂₆H₄₅O

541 − C₁₀H₁₆O₂ 297 C₁₈H₃₃O₃

281 C₁₈H₃₃O₂

279 C₁₈H₃₁O₂

297 − H₂O 279 C₁₈H₃₁O₂

−phytol chain

TABLE 62 MS/MS fragmentation of ovarian cancer biomarker 592.4728. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 591 C₃₆H₆₃O₆

−H⁺ 573 C₃₆H₆₃O₆

−H₂O 529 C₃₆H₆₃O₆

−(CO₂ + H₂O) 313 C₁₈H₃₃O₄

295 C₁₈H₃₁O₃

313 − H₂O

TABLE 63 MS/MS fragmentation of ovarian cancer biomarker 594.4857. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 593 C₃₆H₆₅O₆

−H⁺ 575 C₃₆H₆₅O₅

−H₂O 557 C₃₆H₆₃O₄

−2 × H₂O 549 C₃₅H₆₅O₄

−CO₂ 513 C₃₅H₆₃O₂

549 − CO₂ 495 C₃₅H₆₁O

513 − H₂O 315 C₁₈H₃₅O₄

297 C₁₈H₃₃O₃

315 − H₂O 279 C₁₈H₃₁O₂

421 − H₂O 279 C₁₈H₃₁O₂

−phytol chain 201 C₁₂H₂₅O₂

171 C₉H₁₅O₃

141 C₈H₁₃O₂

TABLE 64 MS/MS fragmentation of ovarian cancer biomarker 596.5015. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 595 C₃₆H₆₇O₆

−H⁺ 577 C₃₆H₆₅O₅

−H₂O 559 C₃₆H₆₃O₄

−2 × H₂O 551 C₃₅H₆₇O₂

−CO₂ 515 C₃₅H₆₃O₂

559 − CO₂ 315 C₁₈H₃₅O₄

297 C₁₈H₃₃O₃

315 − H₂O 281 C₁₈H₃₂O₂

−phytol chain 279 C₁₈H₃₁O₂

297 − H₂O 171 C₉H₁₅O₃

155 C₉H₁₅O₂

141 C₉H₁₇O

127 C₈H₁₅O

TABLE 65 MS/MS fragmentation of ovarian cancer biomarker 598.5121. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. m/z (Da) Formula Molecular fragment Fragment loss 597 C₃₆H₆₉O₆

579 C₃₆H₆₇O₅

−H₂O 561 C₃₆H₆₅O₄

−2 × H₂O 517 C₃₅H₆₅O₂

561 − CO₂ 315 C₁₈H₃₅O₄

297 C₁₈H₃₃O₃

315 − H₂O 279 C₁₈H₃₁O₂

297 − H₂O

TABLE 66 P-values between control and ovarian cancer cohorts for each of the C28 markers. Mass (Da) 450 446 468 466 448 464 p-value 1.92E−12 7.66E−17 1.35E−11 8.17E−13 1.57E−12 3.03E−12

TABLE 67 List of gamma Tocoenoic acids included in expanded triple-quadrupole HTS method. Masses are shown in m/z units, which for the listed compounds correspond to units in Daltons. [M-H]parent/[M-H]daughter formula pvalue (Ovarian vs control) 467.4/423.4 C28H46O4 1.4E−06 447.4/385.4 C28H48O4 5.7E−13 501.4/457.4 C28H50O4 4.1E−15 451.4/407.4 C28H48O5 2.9E−04 531.5/469.4 C28H50O5 3.7E−10 529.4/467.4 C28H52O5 6.2E−09 449.4/405.4 C28H52O6 5.3E−08 445.3/383.4 C30H50O4 1.2E−09 477.4/433.4 C30H50O5 6.2E−13 473.4/429.4 C30H52O4 3.4E−11 493.5/449.4 C30H52O5 7.3E−10 535.4/473.4 C30H54O4 2.8E−03 465.4/403.4 C30H54O5 8.4E−11 463.4/419.4 C30H56O6 8.6E−11 517.4/473.4 C32H54O4 4.9E−11 503.4/459.4 C32H54O5 9.6E−15 523.4/461.4 C32H56O4 1.6E−04 519.4/475.4 C32H56O5 7.8E−08 575.5/513.5 C32H56O6 3.4E−09 521.4/477.4 C32H58O5 1.5E−08 483.4/315.3 C32H58O6 4.5E−21 511.4/315.3 C32H60O5 6.9E−16 549.5/487.5 C32H60O6 1.1E−07 491.4/241.2 C34H58O4 3.9E−13 539.4/315.3 C34H60O4 8.0E−03 591.5/555.4 C34H62O5 2.7E−11 579.5/517.5 C36H62O5 3.2E−02 589.5/545.5 C36H62O6 1.7E−14 537.4/475.4 C36H64O5 1.1E−03 489.4/445.4 C36H64O6 1.7E−15 573.5/223.1 C36H68O5 9.2E−16 

What is claimed:
 1. A method for diagnosing a patient's ovarian cancer disease health state or change in health state, or for diagnosing ovarian cancer, or the risk of ovarian cancer in a patient, the method comprising the steps of: a) analyzing at least one blood sample from said patient using a high resolution mass spectrometer to obtain accurate mass intensity data; b) comparing the accurate mass intensity data to corresponding data obtained from one or more than one reference sample to identify an increase or decrease in accurate mass intensity; and c) using said increase or decrease in accurate mass intensity for diagnosing a patient's ovarian cancer health state or change in health state, or for diagnosing ovarian cancer, or the risk of ovarian cancer in said patient, wherein the accurate mass intensity is measured at or ±5 ppm of a hydrogen and electron adjusted accurate mass, or neutral accurate mass, in Daltons, selected from the group consisting of: 492.3841; 590.4597, 447.3436, 450.3735, 502.4055; 484.3793, 577.4801, 490.3678, 548.4442, 466.3659, 494.3973, 576.4762, 592.4728, 464.3531, 467.3716, 448.3565, 574.4597, 594.4857, 595.4889, 594.4878, 518.3974, 574.4638, 504.4195, 534.3913, 576.4768, 519.3329, 532.4507, 538.4270, 566.4554, 440.3532, 520.4131, 596.5015, 597.5070, 530.4370, 541.3148, 510.3943, 474.3736, 575.4631, 578.4930, 512.4083, 597.5068, 522.4323, 478.4050, 596.5056, 593.4743, 568.3848, 598.5121, 558.4653, 550.4609, 559.4687, 578.4909, 783.5780, 850.7030, 540.4393, 446.3413, 482.3605, 521.4195, 524.4454, 540.4407, 541.4420, 579.4967, 580.5101, 610.4853, 616.4670, 749.5365, 750.5403, 784.5813, 785.5295, 814.5918, 829.5856, 830.5885, 830.6539, 851.7107, 244.0560, 306.2570, 508.3783, 513.4117, 521.3479, 536.4105, 565.3393, 570.4653, 618.4836, 757.5016, 784.5235, 852.7242, 317.9626, 523.3640, 546.4305, 555.3101, 577.4792, 726.5454, 568.4732, 824.6890, 469.3872, 534.4644, 723.5198, 886.5582, 897.5730, 226.0687, 531.3123, 558.4666, 566.3433, 569.4783, 595.4938, 876.7223, 518.3182, 537.4151, 545.3460, 552.3825, 557.4533, 572.4472, 581.5130, 699.5206, 750.5434, 787.5446, 826.7051, 596.4792, 675.6358, 727.5564, 770.5108, 506.3212, 728.5620, 813.5889, 647.5740, 725.5376, 327.0325, 496.3360, 591.3542, 648.5865, 676.6394, 805.5606, 827.7086, 887.5625, 1016.9298, 517.3148, 551.4658, 724.5245, 755.4866, 830.5894, 854.5886, 567.3548, 853.5853, 593.4734, 723.5193, 1017.9341, 649.5898, 560.4799, 751.5529, 481.3171, 556.4504, 646.5709, 749.5402, 794.5128, 821.5717, 829.5859, 840.6067, 496.4165, 729.5726, 807.5762, 819.5553, 626.5286, 857.6171, 808.5794, 852.7196, 505.3227, 566.3433, 592.3570, 541.3422, 542.3452, 779.5438, 785.5936, 786.5403, 758.5654, 1018.9433, 495.3328, 735.6555, 752.5564, 382.1091, 569.3687, 757.5618, 837.5885, 879.7420, 300.2099, 794.5423, 806.5644, 877.7269, 522.4640, 589.3401, 320.2358, 339.9964, 559.4699, 878.7381, 749.5354, 783.5139, 243.0719, 803.5437, 812.5768, 1019.9501, 829.5596, 831.5997, 523.4677, 780.5473, 853.7250, 899.5874, 205.8867, 519.3320, 825.5544, 562.5001, 194.0804, 273.8740, 752.5579, 570.3726, 783.5783, 283.9028, 552.4048, 763.5158, 781.5612, 779.5831, 817.5377, 259.9415, 612.5005, 763.5144, 770.5701, 863.6872, 509.3493, 782.5087, 552.4788, 832.6027, 782.5649, 822.5750, 828.5734, 923.5882, 793.5386, 501.3214, 777.5679, 368.1653, 809.5938, 751.5548, 804.5470, 569.3691, 568.3574, 827.5698, 786.5967, 753.5669, 759.5159, 855.6012, 858.7902, 756.4904, 580.5345, 784.5808, 853.5864, 560.4828, 573.4855, 587.3229, 560.4816, 952.7568, 801.5551, 741.5306, 773.5339, 854.5903, 847.5955, 736.6583, 529.3167, 810.5401, 628.5425, 518.4345, 769.5644, 990.8090, 269.9704, 804.7219, 216.0401, 300.2084, 411.3186, 746.5561, 632.5753, 895.5578, 688.5294, 382.2902, 758.5088, 776.6068, 609.3242, 392.2940, 747.5204, 218.0372, 811.5733, 826.5577, 265.8423, 675.6374, 570.4914, 202.0454, 856.6046, 276.2096, 328.2629, 702.5675, 803.5684, 804.5716, 624.5134, 721.6387, 247.9576, 440.3898, 926.7366, 839.6034, 764.5187, 722.6422, 900.5895, 590.3429, 724.5498, 769.4958, 857.6185, 777.5299, 333.8296, 755.5476, 313.9966, 599.5004, 810.5970, 801.5297, 830.5650, 629.5452, 716.4981, 858.6210, 524.4725, 534.4558, 861.5265, 670.5708, 748.5280, 520.4502, 686.5125, 690.5471, 625.5163, 859.6889, 1251.1152, 763.5150, 269.8081, 829.5620, 745.4973, 541.3138, 1019.3837, 627.5306, 354.1668, 695.6469, 707.6257, 641.4915, 772.5269, 444.3598, 720.2576, 709.2595, 738.5448, 761.5839, 831.5750, 672.5865, 895.5590, 247.9579, 589.3404, 572.4818, 673.5892, 880.7526, 772.5857, 881.7568, 747.5233, 215.9155, 521.4524, 341.8614, 768.4945, 598.4961, 430.3083, 494.4343, 912.8233, 343.8589, 416.3670, 802.5328, 278.2256, 775.5534, 767.5455, 217.9125, 838.7228, 363.3499, 263.8452, 371.3538, 828.7205, 872.5557, 871.5528, 872.7844, 922.8228, 796.5293, 871.5940, 767.5821, 950.7386, 561.4871, 588.3282, 174.1408, 760.5816, 825.5547, 837.7180, 492.4185, 671.5722, 541.3433, 760.5223, 452.2536, 663.5212, 744.4942, 302.2256, 751.5514, 775.5531, 798.6773, 432.3256, 633.3235, 808.5798, 615.3540, 857.8044, 858.7341, 804.7208, 874.5514, 300.2676, 756.5512, 369.3474, 305.2439, 660.5006, 748.5721, 309.3035, 910.7247, 252.2096, 829.7242, 255.0896, 807.5768, and combinations thereof, and wherein said increase or decrease in accurate mass intensity in the blood sample from the patient relative to the corresponding data obtained from said one or more than one reference sample indicates that the patient has ovarian cancer or is at risk of ovarian cancer.
 2. The method according to claim 1, wherein the hydrogen and electron adjusted accurate mass, or neutral accurate mass, is selected from the group consisting of 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, 598.5172 and combinations thereof.
 3. The method according to claim 1, wherein the quantifying data is obtained using a Fourier transform ion cyclotron resonance, time of flight, orbitrap, quadrupole or triple quadrupole mass spectrometer.
 4. The method according to claim 1, wherein the sample is a whole blood sample, a blood serum sample, a subfraction of whole blood, or a blood plasma sample.
 5. The method according to claim 1, wherein the accurate mass intensities represent ionized metabolites.
 6. The method according to claim 31, wherein a liquid/liquid extraction is performed on the at least one blood sample whereby non-polar metabolites are dissolved in an organic solvent and polar metabolites are dissolved in an aqueous solvent.
 7. The method according to claim 6, wherein the accurate mass intensities are obtained from the ionization of the extracted samples using an ionization method selected from the group consisting of: positive electrospray ionization, negative electrospray ionization, positive atmospheric pressure chemical ionization, negative atmospheric pressure chemical ionization, and combinations thereof.
 8. The method according to claim 7, wherein the accurate mass intensity data is obtained using a Fourier transform ion cyclotron resonance mass spectrometer.
 9. The method according to claim 1, further comprising analyzing at least one blood sample from said patient by mass spectrometry to obtain accurate mass intensity data for one or more than one internal control metabolite; and calculating a ratio for each of the accurate mass intensities obtained in step (a) to the accurate mass intensities obtained for the one or more than one internal control metabolite; wherein step (b) comprises comparing each ratio to one or more corresponding ratios obtained for one or more than one reference sample.
 10. The method according to claim 1, wherein the internal control metabolite is cholic acid.
 11. A method for diagnosing individuals who respond to a dietary, chemical, or biological therapeutic strategy designed to prevent, cure, or stabilize ovarian cancer (OC) or improve symptoms associated with OC comprising the steps of: a) analyzing at least one blood sample from said patient using a high resolution mass spectrometer to obtain accurate mass intensity data; b) comparing the accurate mass intensity data to corresponding data obtained from a plurality of OC-negative humans to identify an increase or decrease in accurate mass intensity; and c) using said increase or decrease in accurate mass intensity to determine whether said individual has improved during the therapeutic strategy, wherein the accurate mass intensity is measured at or ±5 ppm of a hydrogen and electron adjusted accurate mass, or neutral accurate mass, in Daltons, selected from the group consisting of: 492.3841; 590.4597, 447.3436, 450.3735, 502.4055; 484.3793, 577.4801, 490.3678, 548.4442, 466.3659, 494.3973, 576.4762, 592.4728, 464.3531, 467.3716, 448.3565, 574.4597, 594.4857, 595.4889, 594.4878, 518.3974, 574.4638, 504.4195, 534.3913, 576.4768, 519.3329, 532.4507, 538.4270, 566.4554, 440.3532, 520.4131, 596.5015, 597.5070, 530.4370, 541.3148, 510.3943, 474.3736, 575.4631, 578.4930, 512.4083, 597.5068, 522.4323, 478.4050, 596.5056, 593.4743, 568.3848, 598.5121, 558.4653, 550.4609, 559.4687, 578.4909, 783.5780, 850.7030, 540.4393, 446.3413, 482.3605, 521.4195, 524.4454, 540.4407, 541.4420, 579.4967, 580.5101, 610.4853, 616.4670, 749.5365, 750.5403, 784.5813, 785.5295, 814.5918, 829.5856, 830.5885, 830.6539, 851.7107, 244.0560, 306.2570, 508.3783, 513.4117, 521.3479, 536.4105, 565.3393, 570.4653, 618.4836, 757.5016, 784.5235, 852.7242, 317.9626, 523.3640, 546.4305, 555.3101, 577.4792, 726.5454, 568.4732, 824.6890, 469.3872, 534.4644, 723.5198, 886.5582, 897.5730, 226.0687, 531.3123, 558.4666, 566.3433, 569.4783, 595.4938, 876.7223, 518.3182, 537.4151, 545.3460, 552.3825, 557.4533, 572.4472, 581.5130, 699.5206, 750.5434, 787.5446, 826.7051, 596.4792, 675.6358, 727.5564, 770.5108, 506.3212, 728.5620, 813.5889, 647.5740, 725.5376, 327.0325, 496.3360, 591.3542, 648.5865, 676.6394, 805.5606, 827.7086, 887.5625, 1016.9298, 517.3148, 551.4658, 724.5245, 755.4866, 830.5894, 854.5886, 567.3548, 853.5853, 593.4734, 723.5193, 1017.9341, 649.5898, 560.4799, 751.5529, 481.3171, 556.4504, 646.5709, 749.5402, 794.5128, 821.5717, 829.5859, 840.6067, 496.4165, 729.5726, 807.5762, 819.5553, 626.5286, 857.6171, 808.5794, 852.7196, 505.3227, 566.3433, 592.3570, 541.3422, 542.3452, 779.5438, 785.5936, 786.5403, 758.5654, 1018.9433, 495.3328, 735.6555, 752.5564, 382.1091, 569.3687, 757.5618, 837.5885, 879.7420, 300.2099, 794.5423, 806.5644, 877.7269, 522.4640, 589.3401, 320.2358, 339.9964, 559.4699, 878.7381, 749.5354, 783.5139, 243.0719, 803.5437, 812.5768, 1019.9501, 829.5596, 831.5997, 523.4677, 780.5473, 853.7250, 899.5874, 205.8867, 519.3320, 825.5544, 562.5001, 194.0804, 273.8740, 752.5579, 570.3726, 783.5783, 283.9028, 552.4048, 763.5158, 781.5612, 779.5831, 817.5377, 259.9415, 612.5005, 763.5144, 770.5701, 863.6872, 509.3493, 782.5087, 552.4788, 832.6027, 782.5649, 822.5750, 828.5734, 923.5882, 793.5386, 501.3214, 777.5679, 368.1653, 809.5938, 751.5548, 804.5470, 569.3691, 568.3574, 827.5698, 786.5967, 753.5669, 759.5159, 855.6012, 858.7902, 756.4904, 580.5345, 784.5808, 853.5864, 560.4828, 573.4855, 587.3229, 560.4816, 952.7568, 801.5551, 741.5306, 773.5339, 854.5903, 847.5955, 736.6583, 529.3167, 810.5401, 628.5425, 518.4345, 769.5644, 990.8090, 269.9704, 804.7219, 216.0401, 300.2084, 411.3186, 746.5561, 632.5753, 895.5578, 688.5294, 382.2902, 758.5088, 776.6068, 609.3242, 392.2940, 747.5204, 218.0372, 811.5733, 826.5577, 265.8423, 675.6374, 570.4914, 202.0454, 856.6046, 276.2096, 328.2629, 702.5675, 803.5684, 804.5716, 624.5134, 721.6387, 247.9576, 440.3898, 926.7366, 839.6034, 764.5187, 722.6422, 900.5895, 590.3429, 724.5498, 769.4958, 857.6185, 777.5299, 333.8296, 755.5476, 313.9966, 599.5004, 810.5970, 801.5297, 830.5650, 629.5452, 716.4981, 858.6210, 524.4725, 534.4558, 861.5265, 670.5708, 748.5280, 520.4502, 686.5125, 690.5471, 625.5163, 859.6889, 1251.1152, 763.5150, 269.8081, 829.5620, 745.4973, 541.3138, 1019.3837, 627.5306, 354.1668, 695.6469, 707.6257, 641.4915, 772.5269, 444.3598, 720.2576, 709.2595, 738.5448, 761.5839, 831.5750, 672.5865, 895.5590, 247.9579, 589.3404, 572.4818, 673.5892, 880.7526, 772.5857, 881.7568, 747.5233, 215.9155, 521.4524, 341.8614, 768.4945, 598.4961, 430.3083, 494.4343, 912.8233, 343.8589, 416.3670, 802.5328, 278.2256, 775.5534, 767.5455, 217.9125, 838.7228, 363.3499, 263.8452, 371.3538, 828.7205, 872.5557, 871.5528, 872.7844, 922.8228, 796.5293, 871.5940, 767.5821, 950.7386, 561.4871, 588.3282, 174.1408, 760.5816, 825.5547, 837.7180, 492.4185, 671.5722, 541.3433, 760.5223, 452.2536, 663.5212, 744.4942, 302.2256, 751.5514, 775.5531, 798.6773, 432.3256, 633.3235, 808.5798, 615.3540, 857.8044, 858.7341, 804.7208, 874.5514, 300.2676, 756.5512, 369.3474, 305.2439, 660.5006, 748.5721, 309.3035, 910.7247, 252.2096, 829.7242, 255.0896, 807.5768, and combinations thereof, and wherein said increase or decrease in accurate mass intensity in the blood sample from the patient relative to the corresponding data obtained from said one or more than one reference sample indicates whether the patient has improved during the therapeutic strategy.
 12. The method according to claim 11, wherein the hydrogen and electron adjusted accurate mass, or neutral accurate mass, is selected from the group consisting of 446.3396, 448.3553, 450.3709, 468.3814, 474.3736, 478.4022, 484.3764, 490.3658, 492.3815, 494.3971, 496.4128, 502.4022, 504.4179, 512.4077, 518.3971, 520.4128, 522.8284, 530.43351, 532.44916, 538.4233, 540.4389, 550.4597, 558.4648, 574.4597, 576.4754, 578.4910, 592.47029, 594.4859, 596.5016, 598.5172 and combinations thereof.
 13. The method according to claim 11, wherein the quantifying data is obtained using a Fourier transform ion cyclotron resonance, time of flight, orbitrap, quadrupole or triple quadrupole mass spectrometer.
 14. The method according to claim 11, wherein the sample is a whole blood sample, a blood serum sample, a subfraction of whole blood, or a blood plasma sample.
 15. The method according to claim 11, wherein the accurate mass intensities represent ionized metabolites.
 16. The method according to claim 11, wherein a liquid/liquid extraction is performed on the at least one blood sample whereby non-polar metabolites are dissolved in an organic solvent and polar metabolites are dissolved in an aqueous solvent.
 17. The method according to claim 16, wherein the accurate mass intensities are obtained from the ionization of the extracted samples using an ionization method selected from the group consisting of: positive electrospray ionization, negative electrospray ionization, positive atmospheric pressure chemical ionization, negative atmospheric pressure chemical ionization, and combinations thereof.
 18. The method according to claim 17, wherein the accurate mass intensity data is obtained using a Fourier transform ion cyclotron resonance mass spectrometer.
 19. The method according to claim 11, further comprising analyzing at least one blood sample from said patient by mass spectrometry to obtain accurate mass intensity data for one or more than one internal control metabolite; and calculating a ratio for each of the accurate mass intensities obtained in step (a) to the accurate mass intensities obtained for the one or more than one internal control metabolite; wherein step (b) comprises comparing each ratio to one or more corresponding ratios obtained for one or more than one reference sample.
 20. The method according to claim 11, wherein the internal control metabolite is cholic acid. 